MEDICARE: SHANTEL DENNIS

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
1	163WP0808X	Psychiatric/Mental Health Registered Nurse	RN211168	GA

General Provider Information

NPI Number	:	1215890587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANTEL DENNIS

Provider Business Mailing Address
First Line	:	538 KYLES CIR
Second Line	:
City	:	HIRAM
State	:	GA
Zip	:	30141-4699
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	538 KYLES CIR
Second Line	:
City	:	HIRAM
State	:	GA
Zip	:	30141-4699
Country	:	US
Telephone Number	:	404-796-1889
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2025
Last Update Date	:	12/04/2025

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Directions to “ SHANTEL DENNIS ” Practice Location

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