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Organization
FIVE STAR DIAGNOSTICS LLC
Active
Organization
FIVE STAR DIAGNOSTICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CEDRIC SHANNON (OWNER/CEO)
(205) 478-1200
Entity
Organization
Contact information
Practice address
1028 GRANDE VIEW PASS, MAYLENE, AL 35114-4004
(205) 478-1200
Mailing address
1028 GRANDE VIEW PASS, MAYLENE, AL 35114-4004
(205) 478-1200
Taxonomy
Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
—
NULL
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
—
—
252Y00000X
Early Intervention Provider Agency
—
NULL
Other
Enumeration date
04/06/2017
Last updated
02/27/2020
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