| Doctor Name: | MRS. SHANNON ETHERIDGE WHITTEN |
| NPI Number: | 1508045840 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.S.,NP-C, APRN,BC, |
| License Number: | R117082 |
| Business Practice Address: | 616 Ferncrest Dr Sandersville, GA - 310821863 |
| Business Phone Number: | 4788643448 |
| Business Fax Number: | 4788641288 |
| Mailing Address: | 616 Ferncrest Dr, SANDERSVILLE |
| State: | GA |
| Postal Code: | 310821863 |
| Phone Number: | 4788643448 |
| Fax Number: | 4788641288 |
| NPI Enumeration Date: | 11/02/2007 |
| NPI Last Update Date: | 12/01/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | R117082 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |