Divine Aesthetics Medspa & Wellness Center Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036.128645 Issued in IL

Legal business name

DIVINE AESTHETICS MEDSPA & WELLNESS CENTER INC

Practice address

6810 S Paxton Ave
Chicago, IL 60649-1603

Phone

(866) 834-8463

NPI assigned

Aug 15, 2013

Last updated

Oct 28, 2013By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Shanicka Williams, M.D.

Title

Owner

Phone

(855) 276-5212

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1376524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1382918400000",
    "number": "1689007403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6810 S PAXTON AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606491603",
            "telephone_number": "866-834-8463"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6810 S PAXTON AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606491603",
            "telephone_number": "866-834-8463"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVINE AESTHETICS MEDSPA & WELLNESS CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-15",
        "last_updated": "2013-10-28",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "SHANICKA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "855-276-5212",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036.128645",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Chicago, IL
• Providers in Chicago, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.