Provider Demographics
NPI:1366672107
Name:COLVIN, SHANNON LEIGH (RNC CNM)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:LEIGH
Last Name:COLVIN
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Gender:F
Credentials:RNC CNM
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Mailing Address - Street 1:6095 PROFESSIONAL PKWY
Mailing Address - Street 2:SUITE A210
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-5607
Mailing Address - Country:US
Mailing Address - Phone:770-949-4188
Mailing Address - Fax:770-949-1614
Practice Address - Street 1:6095 PROFESSIONAL PKWY
Practice Address - Street 2:SUITE A210
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-5607
Practice Address - Country:US
Practice Address - Phone:770-949-4188
Practice Address - Fax:770-949-1614
Is Sole Proprietor?:No
Enumeration Date:2009-07-14
Last Update Date:2014-08-18
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Provider Licenses
StateLicense IDTaxonomies
GA144273367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife