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

Organization subpart

No

Name

Ms. Shanicka Williams, M.D.

Title

Owner

Phone

(855) 276-5212

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Oct 28, 2013.

{
    "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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• All providers in Chicago, IL
• 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.