Healthcare Provider Details

I. General information

NPI: 1659256857
Provider Name (Legal Business Name): SHAYLEECE EDWARDS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHAYLEECE GRAHAM-HARGROVE NP

II. Dates (important events)

Enumeration Date: 08/07/2025
Last Update Date: 12/06/2025
Certification Date: 12/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 BREEDLOVE DR
MONROE GA
30655-2054
US

IV. Provider business mailing address

704 BREEDLOVE DR
MONROE GA
30655-2054
US

V. Phone/Fax

Practice location:
  • Phone: 888-772-0076
  • Fax:
Mailing address:
  • Phone: 888-772-0076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN295523
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: