Provider Demographics
NPI:1144795618
Name:FOREMAN, SHAMETRIAL GLASCOCK (NP-C)
Entity Type:Individual
Prefix:
First Name:SHAMETRIAL
Middle Name:GLASCOCK
Last Name:FOREMAN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:SHAMETRIAL
Other - Middle Name:LITRELL
Other - Last Name:GLASCOCK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP-C
Mailing Address - Street 1:699 FOUR POINTS RD W
Mailing Address - Street 2:
Mailing Address - City:KEYSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30816-4565
Mailing Address - Country:US
Mailing Address - Phone:706-825-3373
Mailing Address - Fax:
Practice Address - Street 1:509 W 4TH ST
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:GA
Practice Address - Zip Code:30830-1514
Practice Address - Country:US
Practice Address - Phone:706-825-3373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-10
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN165946363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily