MRS. SHELLEY DIANE MACK (NPI# 1134435092) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1134435092 |
| Entity Type | Individual |
| Full Name | MRS. SHELLEY DIANE MACK |
| Practice Address |
1514 Baldwin Lakes Dr Grovetown GA 30813-5887 |
| Practice Telephone | 7068540555 |
| Practice Fax Number | 7066519677 |
| Mailing Telephone | 7068540555 |
| Mailing Fax Number | 7066519677 |
| Enumeration Date | 2010-08-29 |
| Last Update Date | 2010-08-29 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 372500000X | Chore Provider | Nursing Service Related Providers | ||
| N | 376J00000X | Homemaker | Nursing Service Related Providers |
| Street Address |
1514 BALDWIN LAKES DR |
| City | GROVETOWN |
| State | GA |
| Zip Code | 30813-5887 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801134739 | Macklander, LLC | Nursing Care | 1514 Baldwin Lakes Dr, Grovetown, GA 30813-5887 | 2013-01-28 |
| 1316285315 | Lizzy's Adult Community Service Center | Clinic/Center | 1514 Baldwin Lakes Dr, Grovetown, GA 30813-5887 | 2013-01-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598276412 | Georgia Dental Professionals, PC | Dentist | 9596 Bentley Dr., Grovetown, GA 30813 | 2017-10-18 |
| 1558891895 | Jennifer M Humm | Dentist | 250 Merridian Drive, Grovetown, GA 30813 | 2017-06-19 |
| 1710335443 | The Kroger Co | Durable Medical Equipment & Medical Supplies | 435 Lewiston Rd, Grovetown, GA 30813 | 2016-06-03 |
| 1558727214 | Lynda R Green | Counselor | 426 Northrop Place, Grovetown, GA 30813 | 2016-01-11 |
| 1689002610 | Patriots Park Dental, LLC | Dentist | 701 Devika Drive, Ste 10, Grovetown, GA 30813 | 2013-10-30 |
| 1255680096 | David Schulte Jr. | Internal Medicine | 925 Branch Ct Ste 2101, Grovetown, GA 30813 | 2012-09-07 |
| 1548519481 | Ashley Roberts Saunders | Pharmacist | 869 Horizon South Parkway, Grovetown, GA 30813 | 2012-09-06 |
| 1447569694 | Wallace Allen Partridge Jr. | Pharmacist | 5104 Wrightsboro Rd., Fred's Pharmacy 1699, Grovetown, GA 30813 | 2010-10-05 |
| 1497908149 | Sharon M Blair | Registered Nurse | 7640 Pleasantville Way, Grovetown, GA 30813 | 2008-10-28 |
| 1710160791 | Rebecca Meek | Nurse Practitioner | 469 Lewiston Rd, Grovetown, GA 30813 | 2007-12-12 |
| Find all providers in zip 30813 | ||||
| Taxonomy Code | 372500000X |
| Grouping | Nursing Service Related Providers |
| Classification | Chore Provider |
| An individual who provides home maintenance services required to sustain a safe, sanitary living environment for individuals who because of age or disabilities is unable to perform the activities. These services include heavy household chores such as washing floors, windows, and walls; tacking down loose rugs and tiles; and moving heavy items of furniture in order to provide safe access and egress. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700492568 | Atrailus Healthcare Inc | Chore Provider | 2453 Powder Springs Rd Sw Ste 325w, Marietta, GA 30064-4570 | 2020-09-17 |
| 1598379547 | Laquietta Christina Keller | Chore Provider | 4503 Reese Rd Apt 205, Columbus, GA 31907-1179 | 2020-09-06 |
| 1265069256 | Three Rivers Housing and Development Corporation | Chore Provider | 326 W. 9th St, Rome, GA 30161 | 2020-03-27 |
| 1538708268 | Tatia Patrice Jackson | Chore Provider | 3448 Pinehill Dr, Decatur, GA 30032-3031 | 2019-12-28 |
| 1619531936 | Ileha M Clark | Chore Provider | 152 New St Ste 103m, Macon, GA 31201-7304 | 2019-04-23 |
| 1285101071 | Valerie Rena Bickham | Chore Provider | 1259 Bismarck Drive, Columbus, GA 31907 | 2018-10-30 |
| 1376028944 | Anthony Mark Crossley | Chore Provider | 4321 S Lee St, Buford, GA 30518-5776 | 2018-09-30 |
| 1396191086 | Suzanne Carter | Chore Provider | 1036 Allgood Rd, Stone Mountain, GA 30083 | 2016-05-11 |
| 1033516091 | Mary Finch | Chore Provider | 2970 Walt Stephens Rd, Jonesboro, GA 30236-4118 | 2014-11-19 |
| 1639509920 | Priscilla Jane Thompson | Chore Provider | 229 Deep South Rd, Senoia, GA 30276 | 2013-11-22 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.