Provider Demographics
NPI:1023598034
Name:LUMPKINS, SHAWANDA
Entity type:Individual
Prefix:
First Name:SHAWANDA
Middle Name:
Last Name:LUMPKINS
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 1:5388 WINDING GLEN DR
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-2396
Mailing Address - Country:US
Mailing Address - Phone:314-659-0888
Mailing Address - Fax:
Practice Address - Street 1:5388 WINDING GLEN DR # FR
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30038-2396
Practice Address - Country:US
Practice Address - Phone:314-659-0888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-19
Last Update Date:2018-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA831493764251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA831493764Medicaid