Provider Demographics
NPI:1356564272
Name:SHOCKLEY, CAROL FRANCES (PHD)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:FRANCES
Last Name:SHOCKLEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 S 10TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224-2803
Mailing Address - Country:US
Mailing Address - Phone:770-233-2822
Mailing Address - Fax:770-233-2810
Practice Address - Street 1:231 S 10TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224-2803
Practice Address - Country:US
Practice Address - Phone:770-233-2822
Practice Address - Fax:770-233-2810
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY 1757103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00589586BMedicaid