Provider Demographics
NPI:1700081817
Name:O'CONNOR, SHAWN THOMAS (ATC)
Entity Type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:THOMAS
Last Name:O'CONNOR
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5843 RIVERSIDE WALK DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR HILL
Mailing Address - State:GA
Mailing Address - Zip Code:30518-7499
Mailing Address - Country:US
Mailing Address - Phone:770-826-1029
Mailing Address - Fax:
Practice Address - Street 1:1180 SATELLITE BLVD NW STE 100
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-4637
Practice Address - Country:US
Practice Address - Phone:404-367-2080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0013022255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer