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General NPI Number Information
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NPI Number | 1366735946
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Entity Type | Individual
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Provider Name | SHEA ANN BOX PA-C
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Gender | Female
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Dates
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Enumeration Date | 05/16/2011
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Last Update Date | 08/15/2017
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Provider Practice Location Address
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Address Line | 80 JESSE HILL JR DR SE SUITE D-332
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City | ATLANTA
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State | GA
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Zip | 30303-3031
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Country | US
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Telephone | 404-616-7257
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Fax |
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Provider Business Mailing Address
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Address Line | 294 LELAND TER NE
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City | ATLANTA
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State | GA
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Zip | 30317-1409
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Country | US
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Telephone | 512-560-1337
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 6110
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License Number State | GA
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