Provider Demographics
NPI:1841670296
Name:SHANNON, EMILY DAVIS (DPT)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:DAVIS
Last Name:SHANNON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6421 PIERLESS AVE
Mailing Address - Street 2:
Mailing Address - City:SUGAR HILL
Mailing Address - State:GA
Mailing Address - Zip Code:30518-7164
Mailing Address - Country:US
Mailing Address - Phone:770-403-0637
Mailing Address - Fax:
Practice Address - Street 1:6421 PIERLESS AVE
Practice Address - Street 2:
Practice Address - City:SUGAR HILL
Practice Address - State:GA
Practice Address - Zip Code:30518-7164
Practice Address - Country:US
Practice Address - Phone:770-403-0637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-01
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT011899225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist