Basic Information
| Provider Information | |||||||||
| NPI: | 1306901426 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ABBOTT | ||||||||
| FirstName: | SHAWN | ||||||||
| MiddleName: | RENEE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | YOUNG | ||||||||
| OtherFirstName: | SHAWN | ||||||||
| OtherMiddleName: | RENEE | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3438 LANTERN VIEW LN | ||||||||
| Address2: | |||||||||
| City: | SCOTTDALE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300796814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042921305 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1440 CLIFTON RD NE | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303221053 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047275658 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 000225 | GA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.