Provider Demographics
NPI:1447886155
Name:SHUMATE, NATALIE BROWN (CPNP)
Entity type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:BROWN
Last Name:SHUMATE
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:MISS
Other - First Name:NATALIE
Other - Middle Name:ROSE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:297 COOPER RD
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-2518
Mailing Address - Country:US
Mailing Address - Phone:678-381-2630
Mailing Address - Fax:678-381-2627
Practice Address - Street 1:297 COOPER RD
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-2518
Practice Address - Country:US
Practice Address - Phone:783-812-6306
Practice Address - Fax:678-381-2627
Is Sole Proprietor?:No
Enumeration Date:2020-03-14
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA175424363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN175424Medicaid