Individual
MR. SHANE CLINTON WILLIAMON I
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNP
Contact information
Practice address
901 KEITH AVENUE, ANNISTON, AL 36202
(256) 236-8611
(256) 236-8636
Mailing address
P.O. BOX 1890, ANNISTON, AL 36203
(256) 236-8611
(256) 236-8636
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
1-078396
AL
Other
Enumeration date
10/19/2009
Last updated
10/19/2009
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