Provider Demographics
NPI:1306072533
Name:JAMESON, SHAKI CHAUDHARY (DMD)
Entity type:Individual
Prefix:DR
First Name:SHAKI
Middle Name:CHAUDHARY
Last Name:JAMESON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:SHAKI
Other - Middle Name:CHAUDHARY
Other - Last Name:JAMESON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:884 STONE CREST RD
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-5673
Mailing Address - Country:US
Mailing Address - Phone:617-504-7537
Mailing Address - Fax:
Practice Address - Street 1:3590 BRASELTON HWY STE 201
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-1120
Practice Address - Country:US
Practice Address - Phone:678-714-7575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-02
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0138651223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry