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General NPI Number Information
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NPI Number | 1417354465
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Entity Type | Individual
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Provider Name | SHANNON OWENSBY RN
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Gender | Female
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Dates
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Enumeration Date | 11/19/2014
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Last Update Date | 11/19/2014
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Provider Practice Location Address
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Address Line | 83 HIGHWAY 48
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City | SUMMERVILLE
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State | GA
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Zip | 30747-1506
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Country | US
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Telephone | 706-857-5441
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Fax |
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Provider Business Mailing Address
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Address Line | 1041 YORK RD
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City | LA FAYETTE
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State | GA
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Zip | 30728-4907
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Country | US
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Telephone |
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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 | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | RN225610
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License Number State | GA
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