Healthcare Provider Details

I. General information

NPI: 1205309333
Provider Name (Legal Business Name): RACHEL ANN SHAVER NNP, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2019
Last Update Date: 01/25/2024
Certification Date: 01/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 15TH ST
AUGUSTA GA
30912-2629
US

IV. Provider business mailing address

1270 HEPHZIBAH MCBEAN RD
HEPHZIBAH GA
30815-4330
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-3813
  • Fax: 706-721-1459
Mailing address:
  • Phone: 706-373-8199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN174883
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberRN174883
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: