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General NPI Number Information
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NPI Number | 1447425053
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Entity Type | Individual
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Provider Name | SHAQUITA STARKS NP
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Gender | Female
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Dates
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Enumeration Date | 04/24/2008
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Last Update Date | 07/23/2024
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Provider Practice Location Address
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Address Line | 1123 CLAIREMONT AVE
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City | DECATUR
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State | GA
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Zip | 30030-1207
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Country | US
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Telephone | 404-738-7542
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Fax | 678-737-1486
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Provider Business Mailing Address
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Address Line | 1123 CLAIREMONT AVE
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City | DECATUR
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State | GA
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Zip | 30030-1207
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Country | US
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Telephone | 404-738-7542
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Fax | 678-737-1486
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | A810588
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 13364
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AC006500
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License Number State | MD
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 166901
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License Number State | GA
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