Healthcare Provider Details

I. General information

NPI: 1245616978
Provider Name (Legal Business Name): SHAINA CONTIGIANI HAZEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2015
Last Update Date: 11/14/2023
Certification Date: 11/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 WHITCHER ST NE STE 130
MARIETTA GA
30060-1156
US

IV. Provider business mailing address

3104 BLUE LAKE DR STE 110
VESTAVIA AL
35243-2372
US

V. Phone/Fax

Practice location:
  • Phone: 770-428-0462
  • Fax: 770-427-8001
Mailing address:
  • Phone: 205-977-1949
  • Fax: 205-977-1933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPAT9108929
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9273
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: