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General NPI Number Information
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NPI Number | 1336793710
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Entity Type | Individual
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Provider Name | SHANICE THURMOND PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/24/2019
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Last Update Date | 03/10/2021
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Provider Practice Location Address
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Address Line | 2201 TALMADGE RD
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City | HAMPTON
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State | GA
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Zip | 30228-1608
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Country | US
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Telephone | 404-564-7005
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Fax |
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Provider Business Mailing Address
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Address Line | 6558 ROSWELL RD APT 1168
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City | ATLANTA
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State | GA
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Zip | 30328-5071
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Country | US
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Telephone | 414-698-9920
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 9934
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License Number State | GA
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