Active NPI
Shanavorn Deaundra McMullen, PT
- Physical Therapist
- Milledgeville, GA
National Provider Identifier
1285873216
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 10972
- Practice address
- 115 Commodore Dr NW
Milledgeville, GA 31061-8211 - Phone
- (478) 457-5621
- NPI assigned
- Feb 15, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 10972 | NC | Primary |
Addresses
Primary practice location
115 Commodore Dr NW
Milledgeville, GA 31061-8211
Mailing address
115 Commodore Dr NW
Milledgeville, GA 31061-8211
Phone (478) 457-5621
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10972 | NC | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1234656000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1234656000000",
"number": "1285873216",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "115 COMMODORE DR NW",
"city": "MILLEDGEVILLE",
"state": "GA",
"postal_code": "310618211",
"telephone_number": "478-457-5621"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "115 COMMODORE DR NW",
"city": "MILLEDGEVILLE",
"state": "GA",
"postal_code": "310618211",
"telephone_number": "478-457-5621"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCMULLEN",
"first_name": "SHANAVORN",
"middle_name": "DEAUNDRA",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-02-15",
"last_updated": "2009-02-15",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NC",
"license": "10972",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Milledgeville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.