Provider Demographics
NPI:1134627151
Name:GARNER-THOMPSON, SHAQUILLE DONOVAN
Entity type:Individual
Prefix:
First Name:SHAQUILLE
Middle Name:DONOVAN
Last Name:GARNER-THOMPSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6840 KNIGHTSWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32818-8852
Mailing Address - Country:US
Mailing Address - Phone:321-877-5453
Mailing Address - Fax:
Practice Address - Street 1:6840 KNIGHTSWOOD DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32818-8852
Practice Address - Country:US
Practice Address - Phone:321-877-5453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-24
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)