Provider Demographics
NPI:1992501555
Name:SCOTT, SHAMEKA ANNETTE (APC)
Entity type:Individual
Prefix:
First Name:SHAMEKA
Middle Name:ANNETTE
Last Name:SCOTT
Suffix:
Gender:
Credentials:APC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6151 TINA LN
Mailing Address - Street 2:
Mailing Address - City:REX
Mailing Address - State:GA
Mailing Address - Zip Code:30273-1125
Mailing Address - Country:US
Mailing Address - Phone:678-394-6622
Mailing Address - Fax:
Practice Address - Street 1:97 ATLANTA ST STE 301
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-2192
Practice Address - Country:US
Practice Address - Phone:470-458-9666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC009828101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty