MEDICARE: MRS. EMILY SHAW DONOVAN FNP-C, AGACNP-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	363LG0600X	Gerontology Nurse Practitioner	APRN-NP240383	GA
2	363LA2100X	Acute Care Nurse Practitioner	2023127641	GA
3	363LF0000X	Family Nurse Practitioner	RN240383	GA

General Provider Information

NPI Number	:	1861919136
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. EMILY SHAW DONOVAN FNP-C, AGACNP-BC

Provider Business Mailing Address
First Line	:	1081 CLUB TRCE NE
Second Line	:
City	:	BROOKHAVEN
State	:	GA
Zip	:	30319-2660
Country	:	US
Telephone Number	:	678-575-3688
Fax Number	:

Provider Business Practice Location Address
First Line	:	550 PEACHTREE ST NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30308-2212
Country	:	US
Telephone Number	:	404-686-2513
Fax Number	:

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

Provider Enumeration Date	:	08/27/2017
Last Update Date	:	04/09/2026

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