Provider Demographics
NPI:1639689896
Name:SHIRLEY, JOHN NELSON (FNP-BC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:NELSON
Last Name:SHIRLEY
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4870 PLAINSMAN CIR
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30028-3463
Mailing Address - Country:US
Mailing Address - Phone:770-316-6087
Mailing Address - Fax:
Practice Address - Street 1:2941 PIEDMONT RD NE STE B
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-2784
Practice Address - Country:US
Practice Address - Phone:404-841-9445
Practice Address - Fax:404-841-9446
Is Sole Proprietor?:No
Enumeration Date:2017-10-02
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2017016476363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily