Provider Demographics
NPI:1790280436
Name:SPARROW, SHANNON KATHLEEN (MD)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:KATHLEEN
Last Name:SPARROW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:100 WOODRUFF CIR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-1020
Mailing Address - Country:US
Mailing Address - Phone:385-319-8064
Mailing Address - Fax:
Practice Address - Street 1:2160 S 1ST AVE BLDG 110
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153-3328
Practice Address - Country:US
Practice Address - Phone:708-327-2561
Practice Address - Fax:708-327-2548
Is Sole Proprietor?:No
Enumeration Date:2018-03-26
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA92341207P00000X
IL125072384207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine