Healthcare Provider Details

I. General information

NPI: 1689025991
Provider Name (Legal Business Name): SHARIAH MCKENZIE SOLOMON CNM, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHARIAH MCKENZIE NP-C

II. Dates (important events)

Enumeration Date: 06/28/2016
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 E LAMAR ST
AMERICUS GA
31709-3737
US

IV. Provider business mailing address

603 E LAMAR ST
AMERICUS GA
31709-3737
US

V. Phone/Fax

Practice location:
  • Phone: 229-928-3444
  • Fax: 229-928-3446
Mailing address:
  • Phone: 229-928-3444
  • Fax: 229-928-3446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN243031
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberRN243031
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: