Provider Demographics
NPI:1154563211
Name:AKER, SHANTIKA S (COTCS)
Entity type:Individual
Prefix:MRS
First Name:SHANTIKA
Middle Name:S
Last Name:AKER
Suffix:
Gender:F
Credentials:COTCS
Other - Prefix:MR
Other - First Name:HEUSTACE
Other - Middle Name:N
Other - Last Name:LEWIS
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:308 GLEN MILNER BLVD
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-3268
Mailing Address - Country:US
Mailing Address - Phone:706-234-4900
Mailing Address - Fax:
Practice Address - Street 1:308 GLEN MILNER BLVD
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30161-3268
Practice Address - Country:US
Practice Address - Phone:706-234-4900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-03
Last Update Date:2009-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2539208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation