Provider Demographics
NPI:1336960467
Name:HOUSTON, SHAQUONZA
Entity type:Individual
Prefix:MRS
First Name:SHAQUONZA
Middle Name:
Last Name:HOUSTON
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 1:154 RAINBOW WAY # 299
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-3994
Mailing Address - Country:US
Mailing Address - Phone:888-462-6602
Mailing Address - Fax:770-202-7167
Practice Address - Street 1:5900 BLUEGRASS VW APT SUITE
Practice Address - Street 2:
Practice Address - City:FAIRBURN
Practice Address - State:GA
Practice Address - Zip Code:30213-4736
Practice Address - Country:US
Practice Address - Phone:678-876-7906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-21
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA451241677187112246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy