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NPI Code Detail

MEDICARE: BEVERLY SHAW FNP-C

MEDICARE: BEVERLY SHAW FNP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerRN207252GA

General Provider Information

NPI Number : 1023548591
Entity Type Code : Individual
Provider Name (Legal Business Name) : BEVERLY SHAW FNP-C
Provider Business Mailing Address
First Line : 3333 RIVERWOOD PKWY SE STE 250
Second Line :
City : ATLANTA
State : GA
Zip : 30339-3304
Country : US
Telephone Number : 770-914-0116
Fax Number : 770-955-4278
Provider Business Practice Location Address
First Line : 1502 W 3RD ST
Second Line :
City : JACKSON
State : GA
Zip : 30233-1979
Country : US
Telephone Number : 770-914-1808
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2017
Last Update Date : 08/16/2022

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Directions to “ BEVERLY SHAW FNP-C” Practice Location

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