Individual
MR. SHAWN MANUEL GEOHAGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNP
Contact information
Practice address
9677 HIGHWAY 21, ATMORE, AL 36502-4271
(251) 368-8122
Mailing address
604 3RD ST, ANDALUSIA, AL 36420-3317
(334) 427-1860
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
1-079148
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1079148
NURSE PRACTITIONER
AL
01
—
5455868
DRIVER'S LIC
AL
Enumeration date
03/05/2007
Last updated
07/08/2007
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