Provider Demographics
NPI:1598047730
Name:BERG, SHAWNA M (FNP)
Entity Type:Individual
Prefix:
First Name:SHAWNA
Middle Name:M
Last Name:BERG
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:SHAWNA
Other - Middle Name:M
Other - Last Name:POULNOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:222 GORDON ST
Mailing Address - Street 2:
Mailing Address - City:BREMEN
Mailing Address - State:GA
Mailing Address - Zip Code:30110-1519
Mailing Address - Country:US
Mailing Address - Phone:770-537-1234
Mailing Address - Fax:770-537-1237
Practice Address - Street 1:820 MAPLE ST
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-3626
Practice Address - Country:US
Practice Address - Phone:678-390-7915
Practice Address - Fax:678-390-7901
Is Sole Proprietor?:No
Enumeration Date:2011-09-14
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN113194363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily