Provider Demographics
NPI:1316605330
Name:SHIALLA WARREN NP CORPORATION
Entity type:Organization
Organization Name:SHIALLA WARREN NP CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHIALLA
Authorized Official - Middle Name:DENEEN
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:404-595-8722
Mailing Address - Street 1:4403 TURNBERRY CT
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-2767
Mailing Address - Country:US
Mailing Address - Phone:404-987-8722
Mailing Address - Fax:
Practice Address - Street 1:12461 VETERANS MEMORIAL HWY STE 805
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-2025
Practice Address - Country:US
Practice Address - Phone:404-595-8722
Practice Address - Fax:678-737-1432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-07
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty