Provider Demographics
NPI:1649855644
Name:WIMES, SHALUNDA D (RN)
Entity type:Individual
Prefix:
First Name:SHALUNDA
Middle Name:D
Last Name:WIMES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 FALCONS RDG
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-7753
Mailing Address - Country:US
Mailing Address - Phone:678-237-6231
Mailing Address - Fax:
Practice Address - Street 1:620 FALCONS RDG
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-7753
Practice Address - Country:US
Practice Address - Phone:678-237-6231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN235338163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003216631AMedicaid