Healthcare Provider Details

I. General information

NPI: 1811429988
Provider Name (Legal Business Name): JAMES SHINHOLSTER JR. NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2017
Last Update Date: 08/20/2020
Certification Date: 08/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 HEMLOCK ST MSC10
MACON GA
31201-2102
US

IV. Provider business mailing address

777 HEMLOCL STREET MSC 117
MACON GA
31201
US

V. Phone/Fax

Practice location:
  • Phone: 478-633-9436
  • Fax:
Mailing address:
  • Phone: 478-633-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN215482
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberRN215482
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: