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General NPI Number Information
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NPI Number | 1104348432
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Entity Type | Individual
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Provider Name | GARRETT SHANE SURRENCY ADVANCED CARE NP
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Gender | Male
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Dates
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Enumeration Date | 07/07/2017
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Last Update Date | 10/20/2025
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Provider Practice Location Address
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Address Line | 189 BO JAMES ST STE 105
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City | CLAYTON
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State | GA
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Zip | 30525-6199
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Country | US
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Telephone | 706-782-0016
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Fax | 706-782-0180
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Provider Business Mailing Address
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Address Line | PO BOX 654
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City | SPARKS
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State | GA
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Zip | 31647-0654
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Country | US
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Telephone | 229-848-9383
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 162472
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License Number State | GA
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