MEDICARE: MR. SHASHANK KUMAR JHA MBBS, FNP, PMHNP-BC

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
1	363LF0000X	Family Nurse Practitioner	RN214076	GA
2	363LF0000X	Family Nurse Practitioner	17634	SC
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	RN214076	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RN 214076	OTHER	GA	GEORGIA BOARD OF NURSING
2	17634	OTHER	SC	SOUTH CAROLINA BOARD OF NURSING

General Provider Information

NPI Number	:	1174800072
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SHASHANK KUMAR JHA MBBS, FNP, PMHNP-BC

Provider Business Mailing Address
First Line	:	445 WINN WAY
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30030-1707
Country	:	US
Telephone Number	:	404-508-3835
Fax Number	:

Provider Business Practice Location Address
First Line	:	2550 SANDY PLAINS RD STE 225
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30066-7256
Country	:	US
Telephone Number	:	770-525-7415
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2011
Last Update Date	:	09/24/2025

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