Healthcare Provider Details

I. General information

NPI: 1689811200
Provider Name (Legal Business Name): JEFFREY DAVID SHIRLEY CNS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2009
Last Update Date: 06/15/2023
Certification Date: 06/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 NEWNAN CROSSING BLVD E STE 210
NEWNAN GA
30265-2576
US

IV. Provider business mailing address

6500 N MO PAC EXPY BLDG. 3, SUITE 200
AUSTIN TX
78731-3282
US

V. Phone/Fax

Practice location:
  • Phone: 770-400-7800
  • Fax:
Mailing address:
  • Phone: 512-458-8400
  • Fax: 512-458-8593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number733869
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberGAA-CNS001441
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: