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General NPI Number Information
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NPI Number | 1619222528
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Entity Type | Individual
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Provider Name | SHAWN WILLIAM MOORE FNP-C
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Gender | Male
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Dates
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Enumeration Date | 07/17/2012
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Last Update Date | 11/14/2025
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Provider Practice Location Address
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Address Line | 400 DAWSON COMMONS CIR STE 410
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City | DAWSONVILLE
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State | GA
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Zip | 30534-6269
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Country | US
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Telephone | 470-773-6725
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Fax | 470-773-6726
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Provider Business Mailing Address
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Address Line | 400 DAWSON COMMONS CIR STE 410
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City | DAWSONVILLE
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State | GA
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Zip | 30534-6269
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Country | US
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Telephone | 470-773-6725
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Fax | 470-773-6726
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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 | 163WR0006X
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Taxonomy Name | Registered Nurse First Assistant
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License Number | RN191172
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | NP191172
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License Number State | GA
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