Provider Demographics
NPI:1316727712
Name:SHIPP, TALISHIA LASHA
Entity type:Individual
Prefix:MS
First Name:TALISHIA
Middle Name:LASHA
Last Name:SHIPP
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 1:3800 CHATTAHOOCHEE SUMMIT DR SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-3247
Mailing Address - Country:US
Mailing Address - Phone:404-360-6809
Mailing Address - Fax:
Practice Address - Street 1:3800 CHATTAHOOCHEE SUMMIT DR SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-3247
Practice Address - Country:US
Practice Address - Phone:404-360-6809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service