Healthcare Provider Details

I. General information

NPI: 1942870241
Provider Name (Legal Business Name): SHANEKIA MARSH NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2021
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 PEACHTREE ST
JESUP GA
31545-0212
US

IV. Provider business mailing address

PO BOX 1520
HINESVILLE GA
31310-8520
US

V. Phone/Fax

Practice location:
  • Phone: 912-385-2453
  • Fax: 912-559-2083
Mailing address:
  • Phone: 912-545-9398
  • Fax: 912-545-2747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11023508
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN216947
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: