Shannon Walls

Primary specialty

Dental TherapistTaxonomy code 125J00000X

Practice address

3255 11 Airborne Division Road
Fort Benning, GA 31801

Phone

(706) 544-9071

NPI assigned

Feb 1, 2022

Last updated

Jul 21, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1643673600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1174276026",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3255 11 AIRBORNE DIVISION ROAD",
            "city": "FORT BENNING",
            "state": "GA",
            "postal_code": "31801",
            "telephone_number": "706-544-9071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3255 11 AIRBORNE DIVISION ROAD",
            "city": "FORT BENNING",
            "state": "GA",
            "postal_code": "31801",
            "telephone_number": "706-544-9071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLS",
        "first_name": "SHANNON",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-02-01",
        "last_updated": "2022-07-21",
        "certification_date": "2022-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "125J00000X",
            "taxonomy_group": "",
            "desc": "Dental Therapist",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3346105139",
            "state": "GA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "SDC",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "3255 11 Airborne Division Road",
            "city": "Fort Benning",
            "state": "GA",
            "country_code": "US",
            "postal_code": "31801",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "sdc",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "3255 11 Airborne Division Road",
            "city": "Fort Benning",
            "state": "GA",
            "country_code": "US",
            "postal_code": "31801",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Karolina Wadolowska
• Andrew Waite, PHARM.D.
• Michael T Wallace, MD
• Brian Steven Wallin, D.O.
• Scharon M Walls
• James Wiggins Walter, MD
• Jennifer Wampler, PA-C
• Christopher Shi Chung Wang, CRNA
• Stephen Wayne Ward, PA-C
• Kyle Christopher Warren, MD

• Dental Therapist in Fort Benning, GA
• Providers in Fort Benning, GA by specialty
• Dental Therapist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.