Shannon C Skiba, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN015253 Issued in GA

Practice address

157 N Main St
Jonesboro, GA 30236-3597

Phone

(770) 478-1001

Fax

(770) 478-1001

NPI assigned

Sep 17, 2009

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1253145600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551484800000",
    "number": "1073846408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "157 N MAIN ST",
            "city": "JONESBORO",
            "state": "GA",
            "postal_code": "302363597",
            "telephone_number": "770-478-1001",
            "fax_number": "770-478-1001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "157 N MAIN ST",
            "city": "JONESBORO",
            "state": "GA",
            "postal_code": "302363597",
            "telephone_number": "770-478-1001",
            "fax_number": "770-478-1001"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "395 N Jefferson Davis",
            "address_purpose": "LOCATION",
            "city": "Fayetteville",
            "state": "GA",
            "postal_code": "302141672",
            "country_code": "US",
            "telephone_number": "770-460-0870",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SKIBA",
        "first_name": "SHANNON",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-09-17",
        "last_updated": "2019-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OH",
            "license": "30.023118",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN015253",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Naniek Simpson
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• Suapsan Singhapakdi, MD
• Lavoris Singleton
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• Kedric Sledge, LCSW
• Smile Wit Confident, LLC
• Wakisha Evelyn Smith Harvey, LPC
• Smith Transitional and Rehabilitation Services, Inc.

• General Practice Dentistry in Jonesboro, GA
• Providers in Jonesboro, GA by specialty
• General Practice Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.