Provider Demographics
NPI:1184696429
Name:THOMAS, SHANNON M (CRNA)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:M
Last Name:THOMAS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MRS
Other - First Name:SHANNON
Other - Middle Name:M
Other - Last Name:POWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:784 SWEET BAY CT
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-4469
Mailing Address - Country:US
Mailing Address - Phone:706-863-4915
Mailing Address - Fax:
Practice Address - Street 1:215 MIMS RD
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:GA
Practice Address - Zip Code:30467-1994
Practice Address - Country:US
Practice Address - Phone:912-564-5253
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN112820367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered