Basic Information
| Provider Information | |||||||||
| NPI: | 1497424543 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GUESS | ||||||||
| FirstName: | SHANNA | ||||||||
| MiddleName: | BROOKE | ||||||||
| NamePrefix: | |||||||||
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| Credential: | APRN | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1035 RED BUD RD NE STE 101 | ||||||||
| Address2: | |||||||||
| City: | CALHOUN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 307016011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7066254285 | ||||||||
| FaxNumber: | 7066253905 | ||||||||
| Practice Location | |||||||||
| Address1: | 1035 RED BUD RD NE STE 101 | ||||||||
| Address2: | |||||||||
| City: | CALHOUN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 307016011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7066254285 | ||||||||
| FaxNumber: | 7066253905 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2021 | ||||||||
| LastUpdateDate: | 03/19/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN175364 | GA | N | Nursing Service Providers | Registered Nurse | 363LF0000X | RN175364 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.