Provider Demographics
NPI:1902367980
Name:EUBANKS, SHELBY DOZIER (NP-C)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:DOZIER
Last Name:EUBANKS
Suffix:
Gender:
Credentials:NP-C
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:FRANCES
Other - Last Name:DOZIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:408 E 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:CORDELE
Mailing Address - State:GA
Mailing Address - Zip Code:31015-3605
Mailing Address - Country:US
Mailing Address - Phone:229-271-2229
Mailing Address - Fax:
Practice Address - Street 1:408 E 3RD AVE
Practice Address - Street 2:
Practice Address - City:CORDELE
Practice Address - State:GA
Practice Address - Zip Code:31015-3605
Practice Address - Country:US
Practice Address - Phone:229-271-2229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-30
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN248977363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE