Provider Demographics
NPI:1477035681
Name:SHAMMAA, JONATHAN JASON (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:JASON
Last Name:SHAMMAA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 GREENO RD S STE B
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-1905
Mailing Address - Country:US
Mailing Address - Phone:251-929-3424
Mailing Address - Fax:
Practice Address - Street 1:300 GREENO RD S STE B
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-1905
Practice Address - Country:US
Practice Address - Phone:251-929-3424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-04
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALL.4811R390200000X
ALMD.42873207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program