MEDICARE: SHANNON GONZALEZ L.AC

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	171100000X	Acupuncturist	420	GA

General Provider Information

NPI Number	:	1437914892
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON GONZALEZ L.AC

Provider Business Mailing Address
First Line	:	718 ARGONNE AVE NE APT 1
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30308-2078
Country	:	US
Telephone Number	:	239-292-8914
Fax Number	:

Provider Business Practice Location Address
First Line	:	502 COMMERCE DR
Second Line	:
City	:	PEACHTREE CITY
State	:	GA
Zip	:	30269-3533
Country	:	US
Telephone Number	:	239-292-8914
Fax Number	:

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

Provider Enumeration Date	:	02/15/2024
Last Update Date	:	02/15/2024

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