Provider Demographics
NPI:1821378381
Name:DEAN, SHANNON LEIGH (PMHNP-BC)
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:LEIGH
Last Name:DEAN
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 CANEFIELD DR
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-8725
Mailing Address - Country:US
Mailing Address - Phone:706-669-2261
Mailing Address - Fax:
Practice Address - Street 1:39 CANEFIELD DR
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-8725
Practice Address - Country:US
Practice Address - Phone:706-669-2261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-27
Last Update Date:2024-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHTC000556183700000X
GARN269221163W00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No183700000XPharmacy Service ProvidersPharmacy TechnicianGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty