Healthcare Provider Details

I. General information

NPI: 1700395027
Provider Name (Legal Business Name): SHELCY ANDREA STEVENS ACUTE CARE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 CARDIOLOGY PL
COMMERCE GA
30529-1083
US

IV. Provider business mailing address

108 ABERDEEN CT
JEFFERSON GA
30549-7225
US

V. Phone/Fax

Practice location:
  • Phone: 770-534-2020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN165525
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: