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General NPI Number Information
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NPI Number | 1205333424
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Entity Type | Individual
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Provider Name | SHELBY LANE ELDER PMHNP
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Gender | Female
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Dates
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Enumeration Date | 04/13/2018
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Last Update Date | 02/09/2026
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Provider Practice Location Address
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Address Line | 505 S CHURCH ST BLDG 4
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City | HAHIRA
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State | GA
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Zip | 31632-1413
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Country | US
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Telephone | 229-414-8813
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Fax | 912-999-3208
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Provider Business Mailing Address
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Address Line | 7381 BEAVER GLEN CIR
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City | HAHIRA
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State | GA
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Zip | 31632-2273
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Country | US
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Telephone | 229-232-2602
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Fax | 912-999-3208
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | RN239452
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License Number State | GA
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