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General NPI Number Information
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NPI Number | 1427441179
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Entity Type | Individual
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Provider Name | SHANETIA SONTAVIA AVINGER NP
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Gender | Female
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Dates
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Enumeration Date | 03/05/2015
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Last Update Date | 07/17/2020
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Provider Practice Location Address
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Address Line | 600 CELEBRATE LIFE PKWY
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City | NEWNAN
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State | GA
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Zip | 30265-8001
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Country | US
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Telephone | 470-241-7628
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Fax |
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Provider Business Mailing Address
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Address Line | 1720 MARS HILL RD NW STE 8-156
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City | ACWORTH
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State | GA
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Zip | 30101-7127
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Country | US
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Telephone | 678-249-4190
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN189154
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License Number State | GA
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