MEDICARE: SHANIKWA GATLIN CNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1427859818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANIKWA GATLIN CNA

Provider Business Mailing Address
First Line	:	1401 WHISPERING PINES RD APT C2
Second Line	:
City	:	ALBANY
State	:	GA
Zip	:	31707-3565
Country	:	US
Telephone Number	:	229-288-1686
Fax Number	:

Provider Business Practice Location Address
First Line	:	1401 WHISPERING PINES RD APT C2
Second Line	:
City	:	ALBANY
State	:	GA
Zip	:	31707-3565
Country	:	US
Telephone Number	:	229-288-1686
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2025
Last Update Date	:	03/21/2025

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