Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 76423 | GA |
NPI | 1023374972 |
---|---|
Provider Name | Shawnay Nicole Mazell |
First Address | Atlanta, GA 30305-1736 |
Second Address | Duluth, GA 30096-4506 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2012 |
Last Update Date | 16/12/2020 |