Provider Demographics
NPI:1336669696
Name:BENEFIELD, SHANNON WORLEY (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:WORLEY
Last Name:BENEFIELD
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8325 HOLLYBERRY LN
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30506-5733
Mailing Address - Country:US
Mailing Address - Phone:678-234-6902
Mailing Address - Fax:
Practice Address - Street 1:3745 CHEROKEE ST NW STE 201
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-6789
Practice Address - Country:US
Practice Address - Phone:770-429-1005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN215310163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant