Provider Demographics
NPI:1831261734
Name:MACK, SHKINIA LOLITA (RN)
Entity type:Individual
Prefix:MS
First Name:SHKINIA
Middle Name:LOLITA
Last Name:MACK
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 1:164 EASTWYCK CIRCLE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032
Mailing Address - Country:US
Mailing Address - Phone:404-241-5522
Mailing Address - Fax:
Practice Address - Street 1:99 JESSE HILL JR DR
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303
Practice Address - Country:US
Practice Address - Phone:404-730-1418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN159995163W00000X, 163WC1500X, 163WW0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Not Answered163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory