MEDICARE: SHONTA JANAI CARUTHERS

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	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1902573298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHONTA JANAI CARUTHERS

Provider Business Mailing Address
First Line	:	5287 ETON DR
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31907-4222
Country	:	US
Telephone Number	:	252-331-9315
Fax Number	:

Provider Business Practice Location Address
First Line	:	5287 ETON DR
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31907-4222
Country	:	US
Telephone Number	:	252-331-9315
Fax Number	:

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

Provider Enumeration Date	:	08/25/2021
Last Update Date	:	08/25/2021

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Directions to “ SHONTA JANAI CARUTHERS ” Practice Location

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