Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 2009-00666 | NC |
NPI | 1003073396 |
---|---|
Provider Name | Shannon Mitchell St Clair |
First Address | Charlotte, NC 28275-1803 |
Second Address | Winston Salem, NC 27103-6946 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2008 |
Last Update Date | 25/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5921382 | (05) | NC |