Provider Demographics
NPI:1215504501
Name:AGNEW MCCOY, SHEILA L
Entity type:Individual
Prefix:MS
First Name:SHEILA
Middle Name:L
Last Name:AGNEW MCCOY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 CARRIAGE OAKS DR # 4
Mailing Address - Street 2:
Mailing Address - City:TYRONE
Mailing Address - State:GA
Mailing Address - Zip Code:30290-1684
Mailing Address - Country:US
Mailing Address - Phone:773-679-5946
Mailing Address - Fax:
Practice Address - Street 1:325 GAELIC WAY
Practice Address - Street 2:
Practice Address - City:TYRONE
Practice Address - State:GA
Practice Address - Zip Code:30290-1866
Practice Address - Country:US
Practice Address - Phone:773-679-5946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date: