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Individual

SHANNON HALL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
P.A.

Contact information

Practice address
1449 BRAMPTON AVE, STATESBORO, GA 30458
(912) 871-2900
Mailing address
1449 BRAMPTON AVE, STATESBORO, GA 30458-0854
(912) 871-2900
(912) 871-2903

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
004827
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
436946365A
GA
05
436946365C
GA
Enumeration date
06/18/2007
Last updated
01/08/2019
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