Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1101X | Ophthalmic Assistant |
NPI | 1972255172 |
---|---|
Provider Name | Shannon Hawkins |
First Address | Atlanta, GA 30308-3545 |
Second Address | Atlanta, GA 30308-3545 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2022 |
Last Update Date | 19/01/2022 |