Provider Demographics
NPI:1982773891
Name:PITMAN, SHANNON LAWRENCE (MD)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:LAWRENCE
Last Name:PITMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:101 RIVERSTONE VIS
Mailing Address - Street 2:STE 211
Mailing Address - City:BLUE RIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30513-6648
Mailing Address - Country:US
Mailing Address - Phone:706-632-3670
Mailing Address - Fax:706-632-5928
Practice Address - Street 1:101 RIVERSTONE VIS
Practice Address - Street 2:STE 211
Practice Address - City:BLUE RIDGE
Practice Address - State:GA
Practice Address - Zip Code:30513-6648
Practice Address - Country:US
Practice Address - Phone:706-632-3670
Practice Address - Fax:706-632-5928
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA060550207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA705001609BMedicaid
GA705001609DMedicaid
GA705001609BMedicaid
GA705001609DMedicaid