Provider Demographics
NPI:1679378640
Name:SHAKIR, LARRY
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:SHAKIR
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 1:3483 EAGLE RISE
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-3560
Mailing Address - Country:US
Mailing Address - Phone:470-807-9529
Mailing Address - Fax:
Practice Address - Street 1:3483 EAGLE RISE
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30038-3560
Practice Address - Country:US
Practice Address - Phone:470-807-9529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-14
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1245843343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)