Individual
SHANICE SHANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1101 HOSPITAL DR STE 100A, STOCKBRIDGE, GA 30281-9076
(770) 474-7416
(770) 692-0761
Mailing address
1101 HOSPITAL DR STE 100A, STOCKBRIDGE, GA 30281-9076
(770) 474-7416
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
01/07/2022
Last updated
03/26/2025
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