Provider Demographics
NPI:1831592682
Name:WIMBERLY, SHANTASIA (ATC)
Entity type:Individual
Prefix:
First Name:SHANTASIA
Middle Name:
Last Name:WIMBERLY
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5070 WARM SPRINGS RD
Mailing Address - Street 2:APT 106
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-4172
Mailing Address - Country:US
Mailing Address - Phone:404-422-8584
Mailing Address - Fax:
Practice Address - Street 1:5070 WARM SPRINGS RD
Practice Address - Street 2:APT 106
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-4172
Practice Address - Country:US
Practice Address - Phone:404-422-8584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-07
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer