| Doctor Name: | SHELLEY-ANN BEAUBRUN |
| NPI Number: | 1083010961 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP-C |
| License Number: | RN193787 |
| Business Practice Address: | 367 Athens Hwy Ste 1050 Loganville, GA - 300522204 |
| Business Phone Number: | 7705542999 |
| Business Fax Number: | 6783536979 |
| Mailing Address: | 367 Athens Hwy, Ste 1050 LOGANVILLE |
| State: | GA |
| Postal Code: | 300522204 |
| Phone Number: | 7705542999 |
| Fax Number: | 6783536979 |
| NPI Enumeration Date: | 11/05/2014 |
| NPI Last Update Date: | 11/05/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LG0600X |
| License Number: | RN193787 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Gerontology |
| Taxonomy Definition: | |