Healthcare Provider Details

I. General information

NPI: 1780509620
Provider Name (Legal Business Name): ADRIAN SHANTAY NOBLES FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1448 LEE BEARD WAY
AUGUSTA GA
30901-3414
US

IV. Provider business mailing address

2804 CRANBROOK DR
HEPHZIBAH GA
30815-6503
US

V. Phone/Fax

Practice location:
  • Phone: 706-828-7468
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP269281
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: