Provider Demographics
NPI:1700876695
Name:SHULER, SHANNON G (MS,FNP,CEN)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:G
Last Name:SHULER
Suffix:
Gender:M
Credentials:MS,FNP,CEN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 BIG A ROAD
Mailing Address - Street 2:
Mailing Address - City:TOCCOA
Mailing Address - State:GA
Mailing Address - Zip Code:30577-6000
Mailing Address - Country:US
Mailing Address - Phone:706-886-3148
Mailing Address - Fax:706-886-2945
Practice Address - Street 1:58 BIG A ROAD
Practice Address - Street 2:
Practice Address - City:TOCCOA
Practice Address - State:GA
Practice Address - Zip Code:30577-6000
Practice Address - Country:US
Practice Address - Phone:706-886-3148
Practice Address - Fax:706-886-2945
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN113834363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA373901783AMedicaid
GA50BBJPBMedicare ID - Type Unspecified
GA373901783AMedicaid