Basic Information
| Provider Information | |||||||||
| NPI: | 1639289002 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SUGARMAN | ||||||||
| FirstName: | SHANNON | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6285 BARFIELD RD NE | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303284335 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4043031224 | ||||||||
| FaxNumber: | 4043031325 | ||||||||
| Practice Location | |||||||||
| Address1: | 11975 MORRIS RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | ALPHARETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300054419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7707513600 | ||||||||
| FaxNumber: | 7707513615 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 07/08/2009 | ||||||||
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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 | 207V00000X | 240900 | NY | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 174400000X | 060490 | GA | N | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 983986738C | 05 | GA | MEDICAID | 983986738A | 05 | GA | MEDICAID | 983986738D | 05 | GA | MEDICAID | 983986738B | 05 | GA | MEDICAID |