Provider Demographics
NPI:1902688070
Name:MCQUEEN, SHERITA A (PHLEBOTOMIST)
Entity Type:Individual
Prefix:
First Name:SHERITA
Middle Name:A
Last Name:MCQUEEN
Suffix:
Gender:F
Credentials:PHLEBOTOMIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:GA
Mailing Address - Zip Code:30474-4917
Mailing Address - Country:US
Mailing Address - Phone:404-940-4611
Mailing Address - Fax:
Practice Address - Street 1:706 ADAMS ST
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474-4917
Practice Address - Country:US
Practice Address - Phone:404-940-4611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-13
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA20-1022Y11156F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist