Provider Demographics
NPI:1942943667
Name:MITCHELL, SHANNON NICOLE (NP)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:NICOLE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:180 RL WHEELER RD
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31211-6700
Mailing Address - Country:US
Mailing Address - Phone:804-712-3853
Mailing Address - Fax:
Practice Address - Street 1:5400 RIVERSIDE DR STE 202
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-0818
Practice Address - Country:US
Practice Address - Phone:478-787-0059
Practice Address - Fax:855-428-4597
Is Sole Proprietor?:No
Enumeration Date:2022-04-20
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN271894363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care