Healthcare Provider Details

I. General information

NPI: 1770362915
Provider Name (Legal Business Name): SHARIEKA ALICIA BALL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2023
Last Update Date: 09/26/2023
Certification Date: 09/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 PEACHTREE ST NE
ATLANTA GA
30308-2212
US

IV. Provider business mailing address

44 WINTER PARK LN
POWDER SPRINGS GA
30127-8600
US

V. Phone/Fax

Practice location:
  • Phone: 404-513-6196
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License NumberRN250876
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: