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General NPI Number Information
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NPI Number | 1841534617
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Entity Type | Individual
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Provider Name | SHANNON WOMACK LPN
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Gender | Female
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Dates
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Enumeration Date | 11/19/2012
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Last Update Date | 05/20/2021
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Provider Practice Location Address
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Address Line | 1775 PARKER RD SE STE 200
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City | CONYERS
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State | GA
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Zip | 30094-6654
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Country | US
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Telephone | 470-778-1148
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1877
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City | CONYERS
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State | GA
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Zip | 30012-7242
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Country | US
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Telephone | 470-778-1148
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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 | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | LPN062876
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License Number State | GA
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