Healthcare Provider Details

I. General information

NPI: 1912867789
Provider Name (Legal Business Name): SHAWANDA TERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2025
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 16TH AVE
COLUMBUS GA
31901-1665
US

IV. Provider business mailing address

4519 WOODRUFF RD STE 4
COLUMBUS GA
31904-6096
US

V. Phone/Fax

Practice location:
  • Phone: 706-320-3700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1-189727
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: