DILLETA ANDREE SHACKELFORD


Address: 520 Griffin Ave, Valdosta, GA 31601-6331
Phone: 2292496302

DILLETA ANDREE SHACKELFORD (NPI# 1811209208) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1811209208
Entity Type Individual
Full Name DILLETA ANDREE SHACKELFORD
Credential APRN
Practice Address 520 Griffin Ave
Valdosta
GA 31601-6331
Practice Telephone 2292496302
Practice Fax Number 2292494009
Mailing Telephone 2292496302
Mailing Fax Number 2292494009
Enumeration Date 2010-07-14
Last Update Date 2010-07-14
Gender Code F
Is Sole Proprietor Y

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 363LX0106X Nurse Practitioner
Specialization: Occupational Health
RN080625 GA Physician Assistants & Advanced Practice Nursing Providers

Office Location

Street Address 520 GRIFFIN AVE
City VALDOSTA
State GA
Zip Code 31601-6331

Providers in the same location

NPI Name Taxonomy Address Enumeration
1801887161 James C Eutzler Emergency Medicine 520 Griffin Ave, Valdosta, GA 31601-6331 2005-11-04
1316573934 Hannah Cheek Registered Nurse 520 Griffin Ave, Valdosta, GA 31601-6331 2020-03-15
1124548300 Lowndes County Partnership for Health Clinic/Center 520 Griffin Ave, Valdosta, GA 31601-6331 2017-06-20
1801133228 Meredith A Schanda Registered Nurse 520 Griffin Ave, Valdosta, GA 31601-6331 2013-01-04
1629129390 Annette Sirmans Robinson Nurse Practitioner 520 Griffin Ave, Valdosta, GA 31601-6331 2007-01-16

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Taxonomy Information

Taxonomy Code 363LX0106X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Nurse Practitioner
Specialization Occupational Health

Taxonomy Definition

Definition to come...

Competitor

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City VALDOSTA
Zip Code 31601

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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