Basic Information
| Provider Information | |||||||||
| NPI: | 1891718870 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PRICE | ||||||||
| FirstName: | SHANNON | ||||||||
| MiddleName: | L. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 39 KENT RD | ||||||||
| Address2: | |||||||||
| City: | TIFTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 317941698 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2293914100 | ||||||||
| FaxNumber: | 2293914508 | ||||||||
| Practice Location | |||||||||
| Address1: | 39 KENT ROAD | ||||||||
| Address2: | |||||||||
| City: | TIFTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 31794 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2293914100 | ||||||||
| FaxNumber: | 2293914508 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2006 | ||||||||
| LastUpdateDate: | 12/01/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | ME105923 | FL | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | LL29196 | SC | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | 69616 | GA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.