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NPI Code Detail

MEDICARE: MRS. GINA HIATT SHUMWAY ACNP-BC

MEDICARE: MRS. GINA HIATT SHUMWAY ACNP-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
1363LA2100XAcute Care Nurse PractitionerRN207614GA
2363L00000XNurse PractitionerRN0000187173TN

General Provider Information

NPI Number : 1710316641
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. GINA HIATT SHUMWAY ACNP-BC
Provider Business Mailing Address
First Line : 1102 W WAUGH ST
Second Line :
City : DALTON
State : GA
Zip : 30720-8769
Country : US
Telephone Number : 706-277-2321
Fax Number :
Provider Business Practice Location Address
First Line : 1102 W WAUGH ST
Second Line :
City : DALTON
State : GA
Zip : 30720-8769
Country : US
Telephone Number : 706-277-2321
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/01/2013
Last Update Date : 08/29/2017

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