Shanta Wade, APRN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

RN261484 Issued in GA

Practice address

619 S 8TH St Ste 100
Griffin, GA 30224-4260

Phone

(678) 248-2899

NPI assigned

Jul 23, 2024

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Peach State Nephrology

  • Nephrology Physician
  • Griffin, GA
  • NPI 1679773774
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1721692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738281600000",
    "number": "1295563278",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "619 S 8TH ST STE 100",
            "city": "GRIFFIN",
            "state": "GA",
            "postal_code": "302244260",
            "fax_number": "770-233-4824"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "619 S 8TH ST STE 100",
            "city": "GRIFFIN",
            "state": "GA",
            "postal_code": "302244260",
            "telephone_number": "678-248-2899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WADE",
        "first_name": "SHANTA",
        "name_prefix": "Mrs.",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-07-23",
        "last_updated": "2025-01-31",
        "certification_date": "2025-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN261484",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vital Hearts HTC LLC
• Vitl Hearts HTC
• Summer Vo
• Kelisa Volson
• Volunteersof America of Georgia Inc.
• Wal-Mart Stores East LP
• Wal-Mart Stores East, LP
• Diante Waldon, CADC-II
• Walgreen Co
• Walgreen Co

• Family Nurse Practitioner in Griffin, GA
• Providers in Griffin, GA by specialty
• Family Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.