Provider Demographics
NPI:1760925135
Name:FENELON, SNAVLY
Entity Type:Individual
Prefix:MRS
First Name:SNAVLY
Middle Name:
Last Name:FENELON
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:SNAVLY
Other - Middle Name:
Other - Last Name:FENELON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:1075 LAFAYETTE PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30241-3507
Mailing Address - Country:US
Mailing Address - Phone:706-443-5273
Mailing Address - Fax:762-323-1014
Practice Address - Street 1:1075 LAFAYETTE PKWY STE 100
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30241-3507
Practice Address - Country:US
Practice Address - Phone:706-443-5273
Practice Address - Fax:762-323-1014
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-02
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAF1016852363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily