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General NPI Number Information
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NPI Number | 1962935999
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Entity Type | Individual
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Provider Name | SHANNON M TRIPPE RN
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Gender | Female
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Dates
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Enumeration Date | 04/06/2017
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Last Update Date | 04/06/2017
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Provider Practice Location Address
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Address Line | 3180 N POINT PKWY SUITE 207
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City | ALPHARETTA
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State | GA
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Zip | 30005-4248
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Country | US
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Telephone | 770-559-8725
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Fax | 770-559-8276
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Provider Business Mailing Address
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Address Line | 6665 GRANITE GATE PASS
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City | CUMMING
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State | GA
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Zip | 30028-2346
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Country | US
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Telephone | 770-688-7392
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Fax | 770-559-8725
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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 | RN123011
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License Number State | GA
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