Provider Demographics
NPI:1578692521
Name:GEOHAGAN, SHAWN MANUEL (CRNP)
Entity Type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:MANUEL
Last Name:GEOHAGAN
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 3RD ST
Mailing Address - Street 2:
Mailing Address - City:ANDALUSIA
Mailing Address - State:AL
Mailing Address - Zip Code:36420-3317
Mailing Address - Country:US
Mailing Address - Phone:334-427-1860
Mailing Address - Fax:
Practice Address - Street 1:9677 HIGHWAY 21
Practice Address - Street 2:
Practice Address - City:ATMORE
Practice Address - State:AL
Practice Address - Zip Code:36502-4271
Practice Address - Country:US
Practice Address - Phone:251-368-8122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-079148363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1079148OtherNURSE PRACTITIONER
AL5455868OtherDRIVER'S LIC