Provider Demographics
NPI:1427577154
Name:SPEIGHTS, SANTEVA SHEANE
Entity type:Individual
Prefix:
First Name:SANTEVA
Middle Name:SHEANE
Last Name:SPEIGHTS
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:PO BOX 249
Mailing Address - Street 2:
Mailing Address - City:HARDWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31034-0249
Mailing Address - Country:US
Mailing Address - Phone:478-234-3384
Mailing Address - Fax:
Practice Address - Street 1:111 HARDWICK ST
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-3889
Practice Address - Country:US
Practice Address - Phone:478-234-3384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-13
Last Update Date:2017-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA813212900Medicaid