MEDICARE: SHANTERIA GAINES

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	106S00000X	Behavior Technician		GA

General Provider Information

NPI Number	:	1811572217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANTERIA GAINES

Provider Business Mailing Address
First Line	:	6003 VETERANS PKWY
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31909-6200
Country	:	US
Telephone Number	:	229-603-2917
Fax Number	:

Provider Business Practice Location Address
First Line	:	6003 VETERANS PKWY
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31909-6200
Country	:	US
Telephone Number	:	229-603-2917
Fax Number	:

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

Provider Enumeration Date	:	03/17/2021
Last Update Date	:	02/18/2025

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Directions to “ SHANTERIA GAINES ” Practice Location

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