Basic Information
Provider Information
NPI: 1003802737
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HANLEY
FirstName: SHEILA
MiddleName: M
NamePrefix:  
NameSuffix:  
Credential: CRNA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 6335 HOSPITAL PKWY STE 111
Address2: ATTN: CREDENTIALING DEPT.
City: JOHNS CREEK
State: GA
PostalCode: 300971550
CountryCode: US
TelephoneNumber: 4047788311
FaxNumber: 7704951585
Practice Location
Address1: 6335 HOSPITAL PKWY STE 111
Address2: ATTN: CREDENTIALING DEPT.
City: JOHNS CREEK
State: GA
PostalCode: 300971550
CountryCode: US
TelephoneNumber: 4047788311
FaxNumber: 7704951585
Other Information
ProviderEnumerationDate: 09/27/2005
LastUpdateDate: 07/31/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367500000XRN096505GAY Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

ID Information
IDTypeStateIssuerDescription
000549766I05GA MEDICAID
000549766A05GA MEDICAID
000549766J05GA MEDICAID


Home