| Shine Healthcare Group | |
|
3250 Creek Water Ct #615 Lawrenceville GA 30044 | |
| (678) 469-9526 | |
| Not Available |
| Full Name | Shine Healthcare Group |
|---|---|
| Speciality | Social Worker |
| Location | 3250 Creek Water Ct #615, Lawrenceville, Georgia |
| Authorized Official Name and Position | Jasmin Booker (CEO) |
| Authorized Official Contact | 4044917716 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shine Healthcare Group 3631 Chamblee Tucker Rd Ste A #288 Atlanta GA 30341 Ph: (678) 469-9526 | Shine Healthcare Group 3250 Creek Water Ct #615 Lawrenceville GA 30044 Ph: (678) 469-9526 |
| NPI Number | 1851012694 |
|---|---|
| Provider Enumeration Date | 09/09/2022 |
| Last Update Date | 09/09/2022 |
| Certification Date | 09/06/2022 |
| Medicare PECOS PAC ID | 3274903950 |
|---|---|
| Medicare Enrollment ID | O20221222000599 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851012694 | NPI | - | NPPES |
| 0 | Other | 0 |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Elizabeth P Hubbs |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1346689817 PECOS PAC ID: 7911148911 Enrollment ID: I20130801000793 |
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