Healthcare Provider Details

I. General information

NPI: 1588091995
Provider Name (Legal Business Name): SHANIQUE L ADAMS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2013
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2011 WINDSOR SPRING RD
AUGUSTA GA
30906-4957
US

IV. Provider business mailing address

PO BOX 2510
EVANS GA
30809-2510
US

V. Phone/Fax

Practice location:
  • Phone: 706-798-1700
  • Fax: 706-798-8626
Mailing address:
  • Phone: 706-922-8251
  • Fax: 706-922-6695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN185519
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP185519
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: