Individual
DR. SHANNON GAMMILL BERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1635 MARVEL ST, COUSHATTA, LA 71019-9022
(318) 932-2000
Mailing address
1635 MARVEL ST, COUSHATTA, LA 71019-9022
(318) 932-2000
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
208173
LA
207Q00000X
Family Medicine Physician
P1727
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2400894
—
LA
01
—
P01575286
RAILROAD MEDICARE PTAN
LA
Enumeration date
06/05/2009
Last updated
10/25/2016
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