Walls, Shannon
Walls, Shannon is an sole proprietor health care provider with primary practice located at 3255 11 Airborne Division Road , Fort Benning GA 31801. She recently has only one registered license in Dental Providers / Dental Therapist, which is considered as her primary health care specialty. Walls, Shannon can be contacted via phone (706) 544-9071.Contact Information
Primary practice address
3255 11 Airborne Division Road
Fort Benning GA 31801
Phone: (706) 544-9071
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Dental Therapist | 125J00000X | Georgia |
Profile Details
| NPI number | 1174276026 |
|---|---|
| LBN Legal business name | Walls, Shannon |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Feb 1st, 2022 |
| Last updated | Jul 21st, 2022 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1174276026 | NPPES |
| Georgia | MEDICAID | 3346105139 |
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