Provider Demographics
NPI:1265176416
Name:QUARLES, LAKESHA SHAUNTA
Entity type:Individual
Prefix:
First Name:LAKESHA
Middle Name:SHAUNTA
Last Name:QUARLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8595 PELHAM RD STE 400501
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-5759
Mailing Address - Country:US
Mailing Address - Phone:864-517-9408
Mailing Address - Fax:
Practice Address - Street 1:8595 PELHAM RD STE 400501
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-5759
Practice Address - Country:US
Practice Address - Phone:864-517-9408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-25
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker