Individual
SHANNON WOODALL BETSILL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
2500 HOSPITAL BLVD, SUITE 480, ROSWELL, GA 30076
(678) 762-0676
(678) 762-7980
Mailing address
PO BOX 740209, DEPT. 1029, ATLANTA, GA 30374-0209
(941) 360-1566
(941) 358-9818
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN111983
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000776685
—
GA
Enumeration date
03/17/2006
Last updated
07/12/2018
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