Healthcare Provider Details

I. General information

NPI: 1053407759
Provider Name (Legal Business Name): DAVID SHANE SNYDER SR. RNFA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 11/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3860 OLD PATH XING
SUWANEE GA
30024-6043
US

IV. Provider business mailing address

3860 OLD PATH XING
SUWANEE GA
30024-6043
US

V. Phone/Fax

Practice location:
  • Phone: 678-481-8126
  • Fax: 770-886-7881
Mailing address:
  • Phone: 678-481-8126
  • Fax: 770-889-0190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN155114
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: