Provider Demographics
NPI:1861919136
Name:DONOVAN, EMILY SHAW (FNP-C)
Entity type:Individual
Prefix:MS
First Name:EMILY
Middle Name:SHAW
Last Name:DONOVAN
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 1:7150 FAWN LAKE DR
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-3648
Mailing Address - Country:US
Mailing Address - Phone:678-575-3688
Mailing Address - Fax:
Practice Address - Street 1:7150 FAWN LAKE DR
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-3648
Practice Address - Country:US
Practice Address - Phone:678-575-3688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-27
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN240383363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily