Provider Demographics
NPI:1598897746
Name:HOLCOMB, SHANNA BARBARA (MD)
Entity Type:Individual
Prefix:
First Name:SHANNA
Middle Name:BARBARA
Last Name:HOLCOMB
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 1:121 HARMONY XING STE 1
Mailing Address - Street 2:
Mailing Address - City:EATONTON
Mailing Address - State:GA
Mailing Address - Zip Code:31024-9573
Mailing Address - Country:US
Mailing Address - Phone:762-220-1222
Mailing Address - Fax:
Practice Address - Street 1:121 HARMONY XING STE 1
Practice Address - Street 2:
Practice Address - City:EATONTON
Practice Address - State:GA
Practice Address - Zip Code:31024-9573
Practice Address - Country:US
Practice Address - Phone:762-220-1222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA64825207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003104420AMedicaid
GA202I162850Medicare UPIN