MEDICARE: DR. SHANNON WAITS CREASMAN DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN011575	GA

General Provider Information

NPI Number	:	1417101551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHANNON WAITS CREASMAN DMD

Provider Business Mailing Address
First Line	:	3330 PIEDMONT RD NE
Second Line	:	STE 13
City	:	ATLANTA
State	:	GA
Zip	:	30305-1726
Country	:	US
Telephone Number	:	404-237-5330
Fax Number	:	404-237-5360

Provider Business Practice Location Address
First Line	:	3330 PIEDMONT RD NE
Second Line	:	STE 13
City	:	ATLANTA
State	:	GA
Zip	:	30305-1726
Country	:	US
Telephone Number	:	404-237-5330
Fax Number	:	404-237-5360

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/14/2008
Last Update Date	:	03/23/2010

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