SHANE ELLISON HORTON PA-C NPI 1992568737

NPI Information

  • NPI: 1992568737
  • Provider Name: SHANE ELLISON HORTON, PA-C
  • Classification: Physician Assistant - 363AS0400X
  • Specialization: Surgical
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 1371 CHURCH STREET EXT NE STE 200
    MARIETTA, GA
    ZIP 30060
  • Phone: (678) 931-8091

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NPI Details

Shane Ellison Horton, PA-C is a surgical physician assistant in Marietta, GA with 2 years of experience. Shane Ellison Horton, PA-C NPI is 1992568737. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

Education
Medical School: LINCOLN MEM UNIV, DEBUSK COL OF OSTEOPATHIC MED
Graduation Year:2023

The provider's business location address is:

1371 CHURCH STREET EXT NE STE 200
MARIETTA, GA
ZIP 30060-913
Phone: (678) 931-8091

The NPI 1992568737 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 2/5/2024 and was last updated on 4/26/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363AS0400XPhysician AssistantSurgical12133GEORGIAYes
2208800000XUrology12133GEORGIANo

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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