Healthcare Provider Details

I. General information

NPI: 1598676124
Provider Name (Legal Business Name): SHANEAN BATTS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3993 LAWRENCEVILLE HWY NW STE 110
LILBURN GA
30047-2831
US

IV. Provider business mailing address

415 EDGEMONT LN
MCDONOUGH GA
30253-8790
US

V. Phone/Fax

Practice location:
  • Phone: 954-393-7615
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: