Provider Demographics
NPI:1386690881
Name:W. G. SHANNON, MD, PA
Entity Type:Organization
Organization Name:W. G. SHANNON, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:W.
Authorized Official - Middle Name:GARY
Authorized Official - Last Name:SHANNON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-210-6809
Mailing Address - Street 1:108 DORSETT DR
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-2277
Mailing Address - Country:US
Mailing Address - Phone:704-210-6809
Mailing Address - Fax:704-210-6819
Practice Address - Street 1:108 DORSETT DR
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-2277
Practice Address - Country:US
Practice Address - Phone:704-210-6809
Practice Address - Fax:704-210-6819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty