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General NPI Number Information
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NPI Number | 1134863855
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Entity Type | Individual
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Provider Name | SHANNON COLEMAN MD
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Gender | Female
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Dates
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Enumeration Date | 04/27/2022
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Last Update Date | 09/08/2025
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Provider Practice Location Address
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Address Line | 49 JESSE HILL JR DR SE
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City | ATLANTA
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State | GA
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Zip | 30303-3049
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Country | US
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Telephone | 404-778-1440
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Fax |
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Provider Business Mailing Address
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Address Line | 300 PROSPECT AVE
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City | EAST AURORA
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State | NY
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Zip | 14052-2216
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Country | US
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Telephone | 716-863-7787
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 105576
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License Number State | GA
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