Provider Information for 1629666490
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SHENA LOCKE
Sex: Female
NPI: 1629666490
Last Updated: 2021-01-06
Certification Date: 2021-01-06
Certification Date: 2021-01-06
Details
| Name | Value | ||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1629666490 | ||||||||||||||
| Enumeration Date | 2021-01-06 | ||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||
| Sole Proprietor | NO | ||||||||||||||
| Status | Active | ||||||||||||||
| Mailing Address | 1640 HABERSHAL RD NW ATLANTA, GA 30318-4041 United States Phone: 404-783-8135 | Fax: | ||||||||||||||
| Primary Practice Address | 401 S MAIN ST STE A8 ALPHARETTA, GA 30009-1957 United States Phone: 404-783-8135 | Fax: | ||||||||||||||
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