Provider Demographics
NPI:1245815752
Name:HALL, SHANNON JOYNER
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:JOYNER
Last Name:HALL
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 1:3651 S CENTER CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:THURMOND
Mailing Address - State:NC
Mailing Address - Zip Code:28683-9773
Mailing Address - Country:US
Mailing Address - Phone:336-468-7367
Mailing Address - Fax:
Practice Address - Street 1:500 CHATHAM MEDICAL PARK
Practice Address - Street 2:
Practice Address - City:ELKIN
Practice Address - State:NC
Practice Address - Zip Code:28621-2481
Practice Address - Country:US
Practice Address - Phone:336-835-3136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5014145363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily