Provider Demographics
NPI:1992321970
Name:WILLIAMS, SHANNON MARIE (CAREGIVER)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:MARIE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CAREGIVER
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:MARIE
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5056 PARKWAY
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:AL
Mailing Address - Zip Code:35064-2213
Mailing Address - Country:US
Mailing Address - Phone:205-370-0804
Mailing Address - Fax:
Practice Address - Street 1:1 CHASE CORPORATE DR STE 400
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-7001
Practice Address - Country:US
Practice Address - Phone:205-370-0804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-25
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL372600000X, 374U00000X, 314000000X, 315D00000X, 374U00000X, 385H00000X, 372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
No385H00000XRespite Care FacilityRespite Care