Provider Demographics
NPI:1285375287
Name:SHANKS, HEATHER MARIE (DO)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:MARIE
Last Name:SHANKS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SBRMC FAMILY MEDICINE RESIDENCY CLINIC
Mailing Address - Street 2:1851 N. MCKENZIE ST SUITE 200
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36535
Mailing Address - Country:US
Mailing Address - Phone:251-424-1488
Mailing Address - Fax:
Practice Address - Street 1:SBRMC FAMILY MEDICINE RESIDENCY CLINIC
Practice Address - Street 2:1851 N. MCKENZIE ST SUITE 200
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535
Practice Address - Country:US
Practice Address - Phone:251-424-1488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program