Individual
SHANNON WILLIAMS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LDO
Contact information
Practice address
34 BIRCH CIR, PORT WENTWORTH, GA 31407-3376
(912) 650-1161
Mailing address
7306 STATE HIGHWAY 21 # 268, PORT WENTWORTH, GA 31407-9274
(912) 373-6797
Taxonomy
Speciality
Code
Description
License number
State
156FC0800X
Contact Lens Technician/Technologist
615
SC
156FC0800X
Contact Lens Technician/Technologist
LDO002432
GA
156FX1800X
Optician
1233
SC
156FX1800X
Optician
Primary
LDO002432
GA
Other
Enumeration date
01/02/2020
Last updated
01/02/2020
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