Individual
MRS. ALVINA C SHANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4475 W VILLAGE PKWY, ELLENWOOD, GA 30294-2869
(770) 507-7950
Mailing address
4228 PARK PLACE CIR, ELLENWOOD, GA 30294-1550
(404) 403-9793
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
002735
GA
Other
Enumeration date
08/07/2008
Last updated
12/17/2019
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