=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184744757
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DR. MOYO SHANIECE AKINLOTAN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/29/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1721 WATERFORD LNDG
-----------------------------------------------------
City | MCDONOUGH
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30253-7728
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-272-2740
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 N ZACK HINTON PKWY
-----------------------------------------------------
City | MCDONOUGH
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30253-2316
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-914-6317
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | RPH023273
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------