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General NPI Number Information
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NPI Number | 1962981381
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Entity Type | Individual
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Provider Name | COURTNEY SHAFER CRNA
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Gender | Female
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Dates
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Enumeration Date | 08/07/2018
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Last Update Date | 09/28/2026
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Provider Practice Location Address
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Address Line | 705 DIXIE ST
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City | CARROLLTON
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State | GA
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Zip | 30117-3818
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Country | US
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Telephone | 770-812-9666
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Fax |
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Provider Business Mailing Address
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Address Line | 770 SPALDING HEIGHTS DR
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City | SANDY SPRINGS
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State | GA
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Zip | 30350-5539
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Country | US
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Telephone | 770-401-9190
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 118210
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | APRN-CRNA225244
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN225244
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License Number State | GA
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