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General NPI Number Information
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NPI Number | 1710316641
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Entity Type | Individual
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Provider Name | GINA HIATT SHUMWAY ACNP-BC
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Gender | Female
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Dates
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Enumeration Date | 11/01/2013
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Last Update Date | 08/29/2017
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Provider Practice Location Address
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Address Line | 1102 W WAUGH ST
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City | DALTON
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State | GA
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Zip | 30720-8769
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Country | US
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Telephone | 706-277-2321
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Fax |
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Provider Business Mailing Address
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Address Line | 1102 W WAUGH ST
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City | DALTON
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State | GA
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Zip | 30720-8769
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Country | US
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Telephone | 706-277-2321
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | RN207614
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN0000187173
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License Number State | TN
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