Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 61709 | TN |
N | 207VG0400X | Gynecologist | 01073408A | IN |
Y | 207VX0000X | Obstetrician | 01073408A | IN |
NPI | 1073874608 |
---|---|
Provider Name | Dr. Shannon Fay Renfrow |
First Address | Jackson, TN 38302-0400 |
Second Address | Fot Stewart, GA 31314-5641 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2012 |
Last Update Date | 15/09/2020 |