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General NPI Number Information
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NPI Number | 1255536413
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Entity Type | Individual
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Provider Name | SHANNON JOHNSON WHEAT MD
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Gender | Female
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Dates
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Enumeration Date | 06/18/2007
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Last Update Date | 10/10/2022
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Provider Practice Location Address
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Address Line | 550 PEACHTREE ST NE
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City | ATLANTA
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State | GA
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Zip | 30308-2212
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Country | US
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Telephone | 470-698-8103
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Fax |
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Provider Business Mailing Address
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Address Line | 550 PEACHTREE ST NE
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City | ATLANTA
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State | GA
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Zip | 30308-2212
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Country | US
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Telephone | 470-698-8103
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | P0416
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | A120902
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 30013
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License Number State | SC
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Taxonomy #4
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 75173
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License Number State | GA
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