Miss Shaquanda Shantivus Gordon, PMHNP-BC in Fairburn, GA

Miss Shaquanda Shantivus Gordon, PMHNP-BC is a medicare enrolled "Nurse Practitioner - Psychiatric/mental Health" in Fairburn, Georgia. Her current practice location is 825 Belmar Pass, Fairburn, Georgia. You can reach out to her office (for appointments etc.) via phone at (229) 603-2601.

Miss Shaquanda Shantivus Gordon is licensed to practice in Georgia (license number 2023060174) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1891475430.

Contact Information

	Miss Shaquanda Shantivus Gordon, PMHNP-BC
	825 Belmar Pass, Fairburn, GA 30213-4482
	(229) 603-2601
	Not Available

Map and Direction

Provider's Profile

Full Name	Miss Shaquanda Shantivus Gordon
Gender	Female
Speciality	Nurse Practitioner - Psychiatric/mental Health
Location	825 Belmar Pass, Fairburn, Georgia
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1891475430
Provider Enumeration Date: 07/19/2023
Last Update Date: 07/19/2023

Medicare PECOS Information:

PECOS PAC ID: 9638532096
Enrollment ID: I20230831004487

Medical Identifiers

Medical identifiers for Miss Shaquanda Shantivus Gordon such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1891475430	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
363LP0808X	Nurse Practitioner - Psychiatric/mental Health	2023060174 (Georgia)	Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Miss Shaquanda Shantivus Gordon allows following entities to bill medicare on her behalf.

Entity Name	Inner Community Health
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1891398541 PECOS PAC ID: 8729441852 Enrollment ID: O20230823000046

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Miss Shaquanda Shantivus Gordon is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Miss Shaquanda Shantivus Gordon, PMHNP-BC 825 Belmar Pass, Fairburn, GA 30213-4482 Ph: (229) 603-2601	Miss Shaquanda Shantivus Gordon, PMHNP-BC 825 Belmar Pass, Fairburn, GA 30213-4482 Ph: (229) 603-2601

Reviews and Comments

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Miss Shaquanda Shantivus Gordon, PMHNP-BC - Medicare Nurse Practitioner in Fairburn, GA