Individual
SHANA B DELOACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNM
Contact information
Practice address
242 KING AVENUE STE 120, ATHENS, GA 30606
(706) 475-5700
Mailing address
242 KING AVENUE STE 120, ATHENS, GA 30606
(706) 475-5700
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
RN216236
GA
367A00000X
Advanced Practice Midwife
Primary
RN216236
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003142037J
—
GA
05
—
003142037K
—
GA
05
—
003142037L
—
GA
05
—
003142037M
—
GA
05
—
003142037N
—
GA
05
—
003142037O
—
GA
01
—
04702359
AMERIGROUP
GA
01
—
1368524
WELLCARE
GA
Enumeration date
07/19/2013
Last updated
07/12/2025
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