Healthcare Provider Details

I. General information

NPI: 1003851494
Provider Name (Legal Business Name): SHAMINA JAFFER HENKEL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3520 PIEDMONT RD NE STE 330
ATLANTA GA
30305-1552
US

IV. Provider business mailing address

3520 PIEDMONT RD NE STE 330
ATLANTA GA
30305-1552
US

V. Phone/Fax

Practice location:
  • Phone: 404-351-2008
  • Fax: 404-351-0243
Mailing address:
  • Phone: 404-351-2008
  • Fax: 404-785-6268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number45069
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number45069
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: