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General NPI Number Information
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NPI Number | 1255117271
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Entity Type | Individual
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Provider Name | SHAKEVA TILLER PMHNP
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Gender | Female
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Dates
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Enumeration Date | 09/05/2023
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Last Update Date | 12/11/2025
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Provider Practice Location Address
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Address Line | 135 EAGLES WALK
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-7206
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Country | US
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Telephone | 470-726-4147
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 531
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City | MORELAND
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State | GA
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Zip | 30259-0531
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | RN287171
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License Number State | GA
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