Healthcare Provider Details

I. General information

NPI: 1356665509
Provider Name (Legal Business Name): SHANNON DAWN ZUNDEL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHANNON DAWN OSBORNE PA-C

II. Dates (important events)

Enumeration Date: 03/17/2010
Last Update Date: 02/05/2026
Certification Date: 02/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1413 CHATTANOOGA AVE
DALTON GA
30720-2631
US

IV. Provider business mailing address

1413 CHATTANOOGA AVE
DALTON GA
30720-2631
US

V. Phone/Fax

Practice location:
  • Phone: 706-279-2635
  • Fax: 706-279-2679
Mailing address:
  • Phone: 706-279-2635
  • Fax: 706-279-2679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number005735
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: