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NPI Code Detail

MEDICARE: SHANNON REYNOLDS NP

MEDICARE: SHANNON REYNOLDS NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerRN173458GA

General Provider Information

NPI Number : 1194133348
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNON REYNOLDS NP
Provider Business Mailing Address
First Line : 890 2ND ST STE 201
Second Line :
City : MACON
State : GA
Zip : 31201-6863
Country : US
Telephone Number : 478-745-4322
Fax Number :
Provider Business Practice Location Address
First Line : 890 2ND ST
Second Line : SUITE 201
City : MACON
State : GA
Zip : 31201-6863
Country : US
Telephone Number : 478-745-4322
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/31/2014
Last Update Date : 10/31/2025

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Directions to “ SHANNON REYNOLDS NP” Practice Location

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