Individual
SHANNON L GOLDSMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
822 MAIN ST, ELLISVILLE, MS 39437-2425
(601) 477-2014
(601) 477-9942
Mailing address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 477-2014
(601) 579-5240
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
24285
MS
207Q00000X
Family Medicine Physician
34009767
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0236248
—
OH
05
—
07854358
—
MS
01
—
12114080
CAQH
OH
05
—
3056277
—
OH
Enumeration date
09/11/2007
Last updated
07/09/2020
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