Provider Demographics
NPI:1699347260
Name:LAMAR, SHANNON (CCC-SLP)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:LAMAR
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1731 BRIARVISTA WAY NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-3640
Mailing Address - Country:US
Mailing Address - Phone:478-731-6825
Mailing Address - Fax:
Practice Address - Street 1:1777 NORTHEAST EXPY NE STE 120
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30329-2475
Practice Address - Country:US
Practice Address - Phone:404-228-8558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-13
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
GASLP011636235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist