Provider Demographics
NPI:1003442997
Name:SOWELL, SHANNA LESLIE
Entity type:Individual
Prefix:
First Name:SHANNA
Middle Name:LESLIE
Last Name:SOWELL
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 1:1005 W MARKET ST STE 17
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35611-2454
Mailing Address - Country:US
Mailing Address - Phone:256-233-5000
Mailing Address - Fax:256-233-5361
Practice Address - Street 1:1005 W MARKET ST STE 17
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35611-2454
Practice Address - Country:US
Practice Address - Phone:256-233-5000
Practice Address - Fax:256-233-5361
Is Sole Proprietor?:No
Enumeration Date:2020-03-23
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL48394207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology