Individual
DR. SHANNON VITALE COUVREUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
150 HENRY BURSON AVE 215, CARROLLTON, GA 30117-4466
(770) 214-2121
Mailing address
119 AMBULANCE DR 202, CARROLLTON, GA 30117-3857
(770) 838-8710
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
066586
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003112931A
—
GA
Enumeration date
07/12/2007
Last updated
12/03/2015
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