Basic Information
| Provider Information | |||||||||
| NPI: | 1982895124 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HALL-KRAFT | ||||||||
| FirstName: | SHAWNTE | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 102321 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303680001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7708012500 | ||||||||
| FaxNumber: | 7708032121 | ||||||||
| Practice Location | |||||||||
| Address1: | 1825 HIGHWAY 34 E | ||||||||
| Address2: | ST. 3000 | ||||||||
| City: | NEWNAN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302651325 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7702526767 | ||||||||
| FaxNumber: | 4045645902 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2007 | ||||||||
| LastUpdateDate: | 01/23/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 58186 | GA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 205575013A | 05 | GA | MEDICAID | 511I080434 | 01 | GA | MEDICARE | OTHER |