Provider Demographics
NPI:1881644763
Name:BURTON-SHANNON, CLARINDA (MD)
Entity Type:Individual
Prefix:DR
First Name:CLARINDA
Middle Name:
Last Name:BURTON-SHANNON
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 1:1405 W BADDOUR PKWY STE 105
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-2568
Mailing Address - Country:US
Mailing Address - Phone:615-965-2467
Mailing Address - Fax:615-965-2331
Practice Address - Street 1:1405 W BADDOUR PKWY STE 105
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-2568
Practice Address - Country:US
Practice Address - Phone:615-965-2467
Practice Address - Fax:615-965-2331
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN16592207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3031979OtherMEDICARE PROVIDER NUMBER
TN3031979Medicaid
TN3031977Medicaid
TN3031979OtherMEDICARE PROVIDER NUMBER
TN3031977Medicaid