Healthcare Provider Details

I. General information

NPI: 1851288286
Provider Name (Legal Business Name): SHP PROVIDER NETWORK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2025
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7505 WATERS AVE STE F9
SAVANNAH GA
31406-3822
US

IV. Provider business mailing address

PO BOX 60969
SAVANNAH GA
31420-0969
US

V. Phone/Fax

Practice location:
  • Phone: 912-691-5711
  • Fax:
Mailing address:
  • Phone: 912-691-5711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: MS. KELLY MOONEY
Title or Position: VP, MANAGED CARE
Credential:
Phone: 229-407-0213