1033757547 NPI number — MRS. SHANNA MICHELE TAYLOR LMSW

Table of content: MRS. SHANNA MICHELE TAYLOR LMSW (NPI 1033757547)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033757547 NPI number — MRS. SHANNA MICHELE TAYLOR LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TAYLOR
Provider First Name:
SHANNA
Provider Middle Name:
MICHELE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
POWELL
Provider Other First Name:
SHANNA
Provider Other Middle Name:
MICHELE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1033757547
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/16/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1258 WOODLAND DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOPERTON
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30457-3500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
478-202-3206
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1258 WOODLAND DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOPERTON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30457-3500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/16/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  MSW008788 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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