Provider Demographics
NPI:1740988708
Name:ALLS-TERRELL, SHAQUAYLA
Entity type:Individual
Prefix:MRS
First Name:SHAQUAYLA
Middle Name:
Last Name:ALLS-TERRELL
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 1:145 KIMBELL FARM DR
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:GA
Mailing Address - Zip Code:30248-2167
Mailing Address - Country:US
Mailing Address - Phone:770-776-9495
Mailing Address - Fax:
Practice Address - Street 1:805 PAVILION CT STE D
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-6666
Practice Address - Country:US
Practice Address - Phone:470-597-9097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN205370163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse