Individual
SHANNON WALLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3255 11 AIRBORNE DIVISION ROAD, FORT BENNING, GA 31801
(706) 544-9071
Mailing address
3255 11 AIRBORNE DIVISION ROAD, FORT BENNING, GA 31801
(706) 544-9071
Taxonomy
Speciality
Code
Description
License number
State
125J00000X
Dental Therapist
Primary
—
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3346105139
—
GA
Enumeration date
02/01/2022
Last updated
07/21/2022
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