Provider Demographics
NPI: | 1992065635 |
---|---|
Name: | JOSHI, SHAWNA CARRIGAN (NP) |
Entity type: | Individual |
Prefix: | MRS |
First Name: | SHAWNA |
Middle Name: | CARRIGAN |
Last Name: | JOSHI |
Suffix: | |
Gender: | F |
Credentials: | NP |
Other - Prefix: | |
Other - First Name: | SHAWNA |
Other - Middle Name: | LEE |
Other - Last Name: | CARRIGAN |
Other - Suffix: | |
Other - Last Name Type: | Former Name |
Other - Credentials: | |
Mailing Address - Street 1: | 3495 PIEDMONT ROAD, NE |
Mailing Address - Street 2: | NINE PIEDMONT CENTER |
Mailing Address - City: | ATLANTA |
Mailing Address - State: | GA |
Mailing Address - Zip Code: | 30305 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 404-504-5678 |
Mailing Address - Fax: | 770-339-9037 |
Practice Address - Street 1: | 5440 HILLANDALE DRIVE |
Practice Address - Street 2: | KAISER PERMANENTE PANOLA MEDICAL CENTER |
Practice Address - City: | LITHONIA |
Practice Address - State: | GA |
Practice Address - Zip Code: | 30058 |
Practice Address - Country: | US |
Practice Address - Phone: | 770-322-2777 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2012-05-28 |
Last Update Date: | 2022-04-14 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
GA | RN208965 | 363LA2200X, 363LW0102X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363LW0102X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
No | 363LA2200X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |