Provider Demographics
NPI:1467501999
Name:MCDONALD, SHANNON C (MD)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:C
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:317 SEVEN SPRINGS WAY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027
Mailing Address - Country:US
Mailing Address - Phone:615-377-4999
Mailing Address - Fax:615-377-8830
Practice Address - Street 1:317 SEVEN SPRINGS WAY
Practice Address - Street 2:SUITE 104
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027
Practice Address - Country:US
Practice Address - Phone:615-377-4999
Practice Address - Fax:615-377-8830
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-12-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN40299207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3000023Medicaid
TN3000023Medicaid
P00400709Medicare PIN
TNG88790Medicare UPIN