Healthcare Provider Details

I. General information

NPI: 1801684923
Provider Name (Legal Business Name): SHADAIE ARTWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2025
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2805 LEE CT
CONYERS GA
30012-2872
US

IV. Provider business mailing address

2805 LEE CT
CONYERS GA
30012-2872
US

V. Phone/Fax

Practice location:
  • Phone: 404-330-4281
  • Fax:
Mailing address:
  • Phone: 404-330-4281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: