Provider Demographics
NPI:1760937486
Name:MOWERY, SHANNA B (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:SHANNA
Middle Name:B
Last Name:MOWERY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 GREISON TRL STE F
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-6401
Mailing Address - Country:US
Mailing Address - Phone:770-251-4120
Mailing Address - Fax:770-251-4575
Practice Address - Street 1:770 GREISON TRL STE F
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263
Practice Address - Country:US
Practice Address - Phone:770-251-4120
Practice Address - Fax:770-251-4575
Is Sole Proprietor?:No
Enumeration Date:2016-08-23
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAF0716506363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily