Provider Demographics
NPI:1659907434
Name:SCARBOROUGH, SHANNON CELESTE
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:CELESTE
Last Name:SCARBOROUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 SUMMERS FIELD RD
Mailing Address - Street 2:
Mailing Address - City:BARNESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30204-1765
Mailing Address - Country:US
Mailing Address - Phone:770-584-6939
Mailing Address - Fax:770-229-7435
Practice Address - Street 1:1524 HIGHWAY 16 W
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30223-2046
Practice Address - Country:US
Practice Address - Phone:770-229-7430
Practice Address - Fax:770-229-7435
Is Sole Proprietor?:No
Enumeration Date:2020-03-12
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA180421835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist