Individual
MR. SHANNON MIZE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
208 HUDSON STREET, CUMMING, GA 30040-2432
(770) 889-2090
(770) 781-4373
Mailing address
208 HUDSON STREET, CUMMING, GA 30040-2432
(770) 889-2090
(770) 781-4373
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
018866
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000179803B
—
GA
05
—
00179803B1
—
GA
Enumeration date
08/05/2006
Last updated
09/19/2024
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