Healthcare Provider Details

I. General information

NPI: 1821378381
Provider Name (Legal Business Name): SHANNON LEIGH DEAN PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2011
Last Update Date: 01/28/2024
Certification Date: 01/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 CANEFIELD DR
CARTERSVILLE GA
30120-8725
US

IV. Provider business mailing address

39 CANEFIELD DR
CARTERSVILLE GA
30120-8725
US

V. Phone/Fax

Practice location:
  • Phone: 706-669-2261
  • Fax:
Mailing address:
  • Phone: 706-669-2261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN269221
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN269221
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberPHTC000556
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: