Provider Demographics
NPI:1922694199
Name:JOSEPH, SHAWNTEL (NP-C)
Entity Type:Individual
Prefix:
First Name:SHAWNTEL
Middle Name:
Last Name:JOSEPH
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 1:823 ROSEWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30238-8863
Mailing Address - Country:US
Mailing Address - Phone:404-626-3739
Mailing Address - Fax:
Practice Address - Street 1:823 ROSEWOOD CIR
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30238-8863
Practice Address - Country:US
Practice Address - Phone:404-626-3739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-11
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN201938363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily