Healthcare Provider Details

I. General information

NPI: 1992311252
Provider Name (Legal Business Name): SHANNON BROWN RN, MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2020
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1127 FOLKSTONE DR
MCDONOUGH GA
30253-3927
US

IV. Provider business mailing address

1127 FOLKSTONE DR
MCDONOUGH GA
30253-3927
US

V. Phone/Fax

Practice location:
  • Phone: 678-392-8977
  • Fax:
Mailing address:
  • Phone: 678-392-8977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN185454
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: