Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 5957 | AL |
NPI | 1114264629 |
---|---|
Provider Name | Dr. Joan-Marie Shanahan Manolakis |
First Address | Mobile, AL 36609-3432 |
Second Address | Mobile, AL 36609-3432 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2013 |
Last Update Date | 27/04/2017 |