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NPI Code Detail

MEDICARE: DR. SHANNON NICOLE MYERS M.D.

MEDICARE: DR. SHANNON NICOLE MYERS M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician070628GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1184945339
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SHANNON NICOLE MYERS M.D.
Provider Business Mailing Address
First Line : 3727 EXECUTIVE CENTER DR
Second Line :
City : AUGUSTA
State : GA
Zip : 30907-2398
Country : US
Telephone Number : 706-842-5331
Fax Number : 706-842-5351
Provider Business Practice Location Address
First Line : 3727 EXECUTIVE CENTER DR
Second Line :
City : AUGUSTA
State : GA
Zip : 30907-2398
Country : US
Telephone Number : 706-842-5331
Fax Number : 706-842-5351
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/22/2010
Last Update Date : 06/11/2019

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