Healthcare Provider Details

I. General information

NPI: 1942902325
Provider Name (Legal Business Name): SHANNON CHRISTIAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2161 W SPRING ST STE A
MONROE GA
30655-3196
US

IV. Provider business mailing address

2161 W SPRING ST STE A
MONROE GA
30655-3196
US

V. Phone/Fax

Practice location:
  • Phone: 770-267-8467
  • Fax: 770-267-1600
Mailing address:
  • Phone: 770-267-8467
  • Fax: 770-267-1600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number110821
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: