Individual
SHAWN HOLSONBACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1200 MEMORIAL DR, DALTON, GA 30720-2529
(706) 272-6000
Mailing address
PO BOX 636019, CINCINNATI, OH 45263-6019
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
045242
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00255537
RAILROAD MEDICARE
GA
Enumeration date
08/11/2006
Last updated
11/14/2007
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