MEDICARE: MS. NAIOMI MICHELLE SHOCKLEY CPNP

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	363LP0200X	Pediatric Nurse Practitioner	RN159492	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	20060526	OTHER	GA	PEDS NURSING CERTIFICATIO
2	472261189	OTHER	GA	TAX ID
3	581238651	OTHER	GA	TAX ID #
4	NCO000006	OTHER	GA	NATIONAL BD OF PED NURSE
5	RN159492	OTHER	GA	LICENSE #
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457486425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NAIOMI MICHELLE SHOCKLEY CPNP

Provider Business Mailing Address
First Line	:	1115 MOUNT ZION RD
Second Line	:	SUITE E
City	:	MORROW
State	:	GA
Zip	:	30260-2266
Country	:	US
Telephone Number	:	770-960-9999
Fax Number	:	770-960-0931

Provider Business Practice Location Address
First Line	:	1115 MOUNT ZION RD STE E
Second Line	:
City	:	MORROW
State	:	GA
Zip	:	30260-2266
Country	:	US
Telephone Number	:	770-960-9999
Fax Number	:	770-960-0931

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

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	10/13/2025

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