Healthcare Provider Details

I. General information

NPI: 1285554709
Provider Name (Legal Business Name): SHANNON HARPER LDO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11460 JOHNS CREEK PKWY
JOHNS CREEK GA
30097-1518
US

IV. Provider business mailing address

11460 JOHNS CREEK PKWY
JOHNS CREEK GA
30097-1518
US

V. Phone/Fax

Practice location:
  • Phone: 678-415-5310
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberLDO0011480
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: