Provider Demographics
NPI:1982940540
Name:MERRIMAN, SHAQUITA YVETTE
Entity type:Individual
Prefix:MISS
First Name:SHAQUITA
Middle Name:YVETTE
Last Name:MERRIMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:S.
Other - Middle Name:YVETTE
Other - Last Name:TUCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 19514
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30325-0514
Mailing Address - Country:US
Mailing Address - Phone:404-808-5763
Mailing Address - Fax:
Practice Address - Street 1:1 BISCAYNE DR NW
Practice Address - Street 2:708
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1090
Practice Address - Country:US
Practice Address - Phone:404-808-5763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-28
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHTC014226174400000X
175L00000X
GAMT011362225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No174400000XOther Service ProvidersSpecialist
No175L00000XOther Service ProvidersHomeopath