Provider Demographics
NPI:1265792204
Name:SHAKULA, JUDI L (DPM)
Entity type:Individual
Prefix:
First Name:JUDI
Middle Name:L
Last Name:SHAKULA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:900 CIRCLE 75 PKWY.
Mailing Address - Street 2:STE. 900
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-3084
Mailing Address - Country:US
Mailing Address - Phone:770-384-0284
Mailing Address - Fax:404-446-1957
Practice Address - Street 1:3969 S. COBB DR.
Practice Address - Street 2:STE. 102
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-6358
Practice Address - Country:US
Practice Address - Phone:770-319-5502
Practice Address - Fax:770-434-9010
Is Sole Proprietor?:No
Enumeration Date:2012-05-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GAPOD000581213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAT38835Medicare UPIN
GA202I485424Medicare PIN