Individual
MRS. SHANNON JOHNSON YOUNGER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
724 LEIGH DR, COLUMBUS, MS 39705-3098
(662) 328-3375
(662) 328-3395
Mailing address
724 LEIGH DR, COLUMBUS, MS 39705-3098
(662) 328-3375
(662) 328-3395
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA9110198
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA00395
MISSISSIPPI PA CERTIFICATE
MS
01
—
PA9110198
59-2455010
FL
Enumeration date
02/16/2017
Last updated
04/24/2020
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