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General NPI Number Information
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NPI Number | 1851012694
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Entity Type | Organization
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Legal Business Name | SHINE HEALTHCARE GROUP
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Dates
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Enumeration Date | 09/09/2022
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Last Update Date | 09/09/2022
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Provider Practice Location Address
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Address Line | 3250 CREEK WATER CT #615
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City | LAWRENCEVILLE
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State | GA
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Zip | 30044
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Country | US
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Telephone | 678-469-9526
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Fax |
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Provider Business Mailing Address
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Address Line | 3631 CHAMBLEE TUCKER RD STE A #288
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City | ATLANTA
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State | GA
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Zip | 30341
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Country | US
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Telephone | 678-469-9526
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JASMIN BOOKER
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Credential |
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Telephone | 404-491-7716
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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