Provider Demographics
NPI:1336198720
Name:SHEA, JOANNE G (PAA)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:G
Last Name:SHEA
Suffix:
Gender:F
Credentials:PAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1001 JOHNSON FERRY RD NE
Mailing Address - Street 2:SCOTTISH RITE DEPT OF ANESTHESIA
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342
Mailing Address - Country:US
Mailing Address - Phone:404-785-5932
Mailing Address - Fax:404-785-7977
Practice Address - Street 1:1001 JOHNSON FERRY RD NE
Practice Address - Street 2:SCOTTISH RITE DEPT OF ANESTHESIA
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342
Practice Address - Country:US
Practice Address - Phone:404-785-2008
Practice Address - Fax:404-785-4496
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001128367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA100002598Medicaid