Healthcare Provider Details

I. General information

NPI: 1912251935
Provider Name (Legal Business Name): SHANNON E NEWMAN RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2012
Last Update Date: 07/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7208 HODGSON MEMORIAL DR STE A
SAVANNAH GA
31406
US

IV. Provider business mailing address

900 MOHAWK ST SUITE A
SAVANNAH GA
31419-1708
US

V. Phone/Fax

Practice location:
  • Phone: 912-351-5050
  • Fax: 912-351-5051
Mailing address:
  • Phone: 912-604-2021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN116888
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: