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General NPI Number Information
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NPI Number | 1518761154
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Entity Type | Individual
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Provider Name | SHAWN MCRAE
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Gender | Male
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Dates
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Enumeration Date | 04/02/2025
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Last Update Date | 04/21/2025
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Provider Practice Location Address
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Address Line | 465 WINN WAY STE 221A
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City | DECATUR
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State | GA
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Zip | 30030-1723
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Country | US
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Telephone | 404-292-3810
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Fax |
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Provider Business Mailing Address
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Address Line | 465 WINN WAY
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City | DECATUR
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State | GA
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Zip | 30030-1753
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Country | US
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Telephone | 140-429-2381
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 2025003350
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License Number State | GA
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