Healthcare Provider Details

I. General information

NPI: 1962306415
Provider Name (Legal Business Name): CAROLINE SHAGENA CGC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 HOWELL MILL RD NW STE 625
ATLANTA GA
30318-3185
US

IV. Provider business mailing address

3442 N DRUID HILLS RD APT H
DECATUR GA
30033-3707
US

V. Phone/Fax

Practice location:
  • Phone: 404-425-7300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number926
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: