Healthcare Provider Details

I. General information

NPI: 1962981381
Provider Name (Legal Business Name): COURTNEY SHAFER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COURTNEY LYNN THOMPSON CRNA

II. Dates (important events)

Enumeration Date: 08/07/2018
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 DIXIE ST
CARROLLTON GA
30117-3818
US

IV. Provider business mailing address

770 SPALDING HEIGHTS DR
SANDY SPRINGS GA
30350-5539
US

V. Phone/Fax

Practice location:
  • Phone: 770-812-9666
  • Fax:
Mailing address:
  • Phone: 770-401-9190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number118210
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN-CRNA225244
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN225244
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: