Provider Demographics
NPI:1720267040
Name:ANAKWAH, SHAWNTA SPEER (MD)
Entity Type:Individual
Prefix:
First Name:SHAWNTA
Middle Name:SPEER
Last Name:ANAKWAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 131329
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35213-6329
Mailing Address - Country:US
Mailing Address - Phone:256-492-0375
Mailing Address - Fax:256-492-9811
Practice Address - Street 1:705 GOODYEAR AVE
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35903-1156
Practice Address - Country:US
Practice Address - Phone:256-492-0375
Practice Address - Fax:256-492-9811
Is Sole Proprietor?:No
Enumeration Date:2007-11-02
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA066357207RH0003X, 207RH0003X
AL38504207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALCK5459OtherRAILROAD MEDICARE GROUP PTAN
ALE812OtherMEDICARE GROUP PTAN
AL529931810OtherMEDICAID GROUP NUMBER