Individual
SHANNON STAFFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8408 MARCUS PL STE A, SAVANNAH, GA 31406-4928
(912) 660-4484
Mailing address
3206 FALLIGANT AVE, THUNDERBOLT, GA 31404-5314
(912) 660-4484
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
10/10/2017
Last updated
10/10/2017
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