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General NPI Number Information
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NPI Number | 1578420998
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Entity Type | Organization
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Legal Business Name | DE NOVO BRAIN & SPINE
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Dates
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Enumeration Date | 01/07/2026
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Last Update Date | 01/07/2026
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Provider Practice Location Address
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Address Line | 7444 HANNOVER PKWY S
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-9303
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Country | US
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Telephone | 404-882-3592
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Fax |
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Provider Business Mailing Address
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Address Line | 8735 DUNWOODY PL STE N
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City | ATLANTA
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State | GA
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Zip | 30350-2995
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Country | US
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Telephone | 404-882-3592
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LARRY ROLAND SHANNON II
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Credential | MD
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Telephone | 404-882-3592
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number |
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License Number State |
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