Individual
MR. PHILLIP SHANNON FARRIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C, MPAS.
Contact information
Practice address
1103 16TH AVE SE, DECATUR, AL 35601-3595
(256) 350-0362
Mailing address
2404 11TH ST SE, DECATUR, AL 35601-4598
(256) 353-2018
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-262
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA-262
ALABAMA LICENSE NUMBER
AL
Enumeration date
11/01/2006
Last updated
04/08/2009
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