Healthcare Provider Details

I. General information

NPI: 1134240757
Provider Name (Legal Business Name): ANN PATRICIA SHANNON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 01/03/2025
Certification Date: 01/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2578 HELEN HWY
CLEVELAND GA
30528-2848
US

IV. Provider business mailing address

363 RESOURCE PKWY
WINDER GA
30680-8364
US

V. Phone/Fax

Practice location:
  • Phone: 770-219-9100
  • Fax:
Mailing address:
  • Phone: 770-597-1647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW003738
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: