Provider Demographics
NPI:1912590191
Name:DUERK, SHANNON LEIGH (FNP-C)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:LEIGH
Last Name:DUERK
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 742616
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-2616
Mailing Address - Country:US
Mailing Address - Phone:770-219-8420
Mailing Address - Fax:
Practice Address - Street 1:990 LOGANVILLE HWY STE 105
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:GA
Practice Address - Zip Code:30620-2175
Practice Address - Country:US
Practice Address - Phone:770-848-9300
Practice Address - Fax:770-848-9301
Is Sole Proprietor?:No
Enumeration Date:2021-02-18
Last Update Date:2025-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPRN-NP298736363LF0000X
GARN298736363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily