Provider Demographics
NPI:1023548591
Name:SHAW, BEVERLY (FNP-C)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:
Last Name:SHAW
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:BEVERLY
Other - Middle Name:
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:3333 RIVERWOOD PKWY SE STE 250
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-3304
Mailing Address - Country:US
Mailing Address - Phone:770-914-0116
Mailing Address - Fax:770-955-4278
Practice Address - Street 1:1502 W 3RD ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:GA
Practice Address - Zip Code:30233-1979
Practice Address - Country:US
Practice Address - Phone:770-914-1808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-15
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN207252363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily