Provider Demographics
NPI:1275710899
Name:KAHN, SHANNON TUCKER (MD)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:TUCKER
Last Name:KAHN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:639 KIMBERLY LN NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30306-2224
Mailing Address - Country:US
Mailing Address - Phone:404-641-8665
Mailing Address - Fax:
Practice Address - Street 1:639 KIMBERLY LN NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30306-2224
Practice Address - Country:US
Practice Address - Phone:404-641-8665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-25
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA8609082085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA860908OtherRESIDENT ID NUMBER