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General NPI Number Information
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NPI Number | 1225139959
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Entity Type | Individual
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Provider Name | SHANON REYNOLDS JERNIGAN MD
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Gender | Male
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 10699 OLD HIGHWAY 280 STE B
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City | CHELSEA
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State | AL
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Zip | 35043-8220
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Country | US
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Telephone | 205-335-2310
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Fax |
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Provider Business Mailing Address
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Address Line | 3025 BELVEDERE LN
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City | BIRMINGHAM
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State | AL
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Zip | 35242-6635
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Country | US
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Telephone | 205-335-2310
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 27306
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License Number State | AL
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