Healthcare Provider Details

I. General information

NPI: 1003627209
Provider Name (Legal Business Name): SHELBY CRAIG NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2025
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 GREENE ST STE 200
AUGUSTA GA
30901-2385
US

IV. Provider business mailing address

701 GREENE ST STE 200
AUGUSTA GA
30901-2385
US

V. Phone/Fax

Practice location:
  • Phone: 706-722-6900
  • Fax: 706-722-5118
Mailing address:
  • Phone: 706-722-6900
  • Fax: 706-722-5118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberGAA-NP003865
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberGAA-NP003865
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberGAA-NP003865
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: