Provider Demographics
NPI:1902942063
Name:HOWARD, SHANI JONES (NP)
Entity Type:Individual
Prefix:
First Name:SHANI
Middle Name:JONES
Last Name:HOWARD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 TWELVE OAKS PL STE A
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-4918
Mailing Address - Country:US
Mailing Address - Phone:706-769-7743
Mailing Address - Fax:706-769-9462
Practice Address - Street 1:1020 TWELVE OAKS PL STE A
Practice Address - Street 2:
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-4918
Practice Address - Country:US
Practice Address - Phone:706-769-7743
Practice Address - Fax:706-769-9462
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAR112760363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000814316AMedicaid