Healthcare Provider Details

I. General information

NPI: 1841799269
Provider Name (Legal Business Name): SHANNON AICHELE WOODS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHANNON MARIE AICHELE

II. Dates (important events)

Enumeration Date: 02/12/2018
Last Update Date: 02/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1365 CLIFTON RD NE
ATLANTA GA
30322-1013
US

IV. Provider business mailing address

1050 LENOX PARK BLVD NE APT 12406
BROOKHAVEN GA
30319-5855
US

V. Phone/Fax

Practice location:
  • Phone: 847-571-9721
  • Fax:
Mailing address:
  • Phone: 847-571-9721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberRN210400
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN210400
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: