Individual
MRS. MARYANNE SHEPHARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTIONER
Contact information
Practice address
72 S. BROAD ST., ELLAVILLE, GA 30806-0065
(229) 937-5321
(229) 937-2232
Mailing address
PO BOX 65, ELLAVILLE, GA 31806-0065
(229) 937-5321
(229) 937-2232
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
RN058330
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00000019F
—
GA
Enumeration date
10/23/2006
Last updated
07/08/2007
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