Provider Demographics
NPI:1629134861
Name:DEATON, SHANNON M (DPM)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:M
Last Name:DEATON
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35901-5265
Mailing Address - Country:US
Mailing Address - Phone:256-549-7890
Mailing Address - Fax:256-549-7891
Practice Address - Street 1:230 S 4TH ST
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-5265
Practice Address - Country:US
Practice Address - Phone:256-549-7890
Practice Address - Fax:256-549-7891
Is Sole Proprietor?:No
Enumeration Date:2006-12-30
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL233213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051558978Medicaid
U62896Medicare UPIN