MEDICARE: JOHN NELSON SHIRLEY FNP-BC

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	363LF0000X	Family Nurse Practitioner	2017016476	GA
2	363LF0000X	Family Nurse Practitioner	AP70106932	WA

General Provider Information

NPI Number	:	1639689896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN NELSON SHIRLEY FNP-BC

Provider Business Mailing Address
First Line	:	4870 PLAINSMAN CIR
Second Line	:
City	:	CUMMING
State	:	GA
Zip	:	30028-3463
Country	:	US
Telephone Number	:	770-316-6087
Fax Number	:

Provider Business Practice Location Address
First Line	:	2941 PIEDMONT RD NE STE B
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30305-2784
Country	:	US
Telephone Number	:	404-841-9445
Fax Number	:	404-841-9446

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

Provider Enumeration Date	:	10/02/2017
Last Update Date	:	04/06/2026

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