Provider Demographics
NPI:1326938853
Name:MATHIS, SHANTRELL (PHLEBOMIST)
Entity type:Individual
Prefix:MS
First Name:SHANTRELL
Middle Name:
Last Name:MATHIS
Suffix:
Gender:F
Credentials:PHLEBOMIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4751 BEST RD STE 373
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30337-5615
Mailing Address - Country:US
Mailing Address - Phone:404-533-6100
Mailing Address - Fax:
Practice Address - Street 1:4751 BEST RD STE 373
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30337-5615
Practice Address - Country:US
Practice Address - Phone:404-533-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-07
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory