Provider Demographics
NPI:1306519129
Name:HAILS-CHAPMAN, SHONJUANAKA SHONTA
Entity type:Individual
Prefix:
First Name:SHONJUANAKA
Middle Name:SHONTA
Last Name:HAILS-CHAPMAN
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 1:3986 VALIANT CT
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31605-6909
Mailing Address - Country:US
Mailing Address - Phone:334-294-8599
Mailing Address - Fax:
Practice Address - Street 1:3986 VALIANT CT
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31605-6909
Practice Address - Country:US
Practice Address - Phone:334-294-8599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor