MEDICARE: SHANNON BRABHAM

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	342000000X	Transportation Network Company		GA

General Provider Information

NPI Number	:	1588517940
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON BRABHAM

Provider Business Mailing Address
First Line	:	5532 ROSSER RD
Second Line	:
City	:	STONE MOUNTAIN
State	:	GA
Zip	:	30087-1240
Country	:	US
Telephone Number	:	678-558-8523
Fax Number	:

Provider Business Practice Location Address
First Line	:	5532 ROSSER RD
Second Line	:
City	:	STONE MOUNTAIN
State	:	GA
Zip	:	30087-1240
Country	:	US
Telephone Number	:	678-558-8523
Fax Number	:	844-532-1607

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

Provider Enumeration Date	:	02/17/2026
Last Update Date	:	02/17/2026

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Directions to “ SHANNON BRABHAM ” Practice Location

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