Provider Demographics
NPI:1760667034
Name:CONLON, SHAUN DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAUN
Middle Name:DAVID
Last Name:CONLON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:5667 PEACHTREE DUNWOODY RD STE 260
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1714
Mailing Address - Country:US
Mailing Address - Phone:404-255-1030
Mailing Address - Fax:678-843-6619
Practice Address - Street 1:5667 PEACHTREE DUNWOODY RD STE 260
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1714
Practice Address - Country:US
Practice Address - Phone:404-255-1030
Practice Address - Fax:678-843-6619
Is Sole Proprietor?:No
Enumeration Date:2008-01-07
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA062828207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003178707BMedicaid
GA102I391458Medicare PIN