MEDICARE: SHANA F ANDREWS

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	374J00000X	Doula

General Provider Information

NPI Number	:	1861970360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANA F ANDREWS

Provider Business Mailing Address
First Line	:	1950 ROSWELL RD APT 10B1
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30068-5071
Country	:	US
Telephone Number	:	404-907-5323
Fax Number	:

Provider Business Practice Location Address
First Line	:	1950 ROSWELL RD APT 10B1
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30068-5071
Country	:	US
Telephone Number	:	678-788-0895
Fax Number	:

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

Provider Enumeration Date	:	08/06/2018
Last Update Date	:	08/06/2018

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