Provider Demographics
NPI:1649008814
Name:DAVIS, SHANTEL REMI
Entity type:Individual
Prefix:
First Name:SHANTEL
Middle Name:REMI
Last Name:DAVIS
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 1:8387 SAN JOSE TRL
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-3835
Mailing Address - Country:US
Mailing Address - Phone:470-685-7343
Mailing Address - Fax:
Practice Address - Street 1:8387 SAN JOSE TRL
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-3835
Practice Address - Country:US
Practice Address - Phone:470-685-7343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician