Healthcare Provider Details

I. General information

NPI: 1669875225
Provider Name (Legal Business Name): SHARONDA LASHA BASBY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2014
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2054 WATSON BLVD
WARNER ROBINS GA
31093-3634
US

IV. Provider business mailing address

408 ANGELINA GRACE DR
WARNER ROBINS GA
31088-3295
US

V. Phone/Fax

Practice location:
  • Phone: 478-231-9223
  • Fax: 478-918-0771
Mailing address:
  • Phone: 478-231-9223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number207536
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN207536
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: