Active NPI
Angela P. Shannon, M.D.
- Psychiatry Physician
- Los Angeles, CA
National Provider Identifier
1285707455
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- C168597
- Practice address
- 4211 Avalon Blvd
Los Angeles, CA 90011-5622 - Phone
- (323) 233-0425
- NPI assigned
- Nov 16, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 036661 | GA | |
| Psychiatry Physician | 2084P0800X | C168597 | CA | Primary |
Addresses
Primary practice location
4211 Avalon Blvd
Los Angeles, CA 90011-5622
Mailing address
2099 Fairburn Rd SW
Atlanta, GA 30331-4812
Phone (404) 344-0618
Other practice location 1
2099 Fairburn Rd SW
Atlanta, GA 30331-4812
Phone (404) 344-0618
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C168597 | CA | MD | Psychiatry Physician |
| 036661 | GA | MD | Psychiatry Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Positive Balance Wellness Center @ Ben Hill United Methodist Church | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Health Service Clinic/Center
- Atlanta, GA
- NPI 1356738447
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163635200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1743552000000",
"number": "1285707455",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2099 FAIRBURN RD SW",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303314812",
"telephone_number": "404-344-0618",
"fax_number": "404-344-7810"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4211 AVALON BLVD",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900115622",
"telephone_number": "323-233-0425"
}
],
"practiceLocations": [
{
"address_1": "2099 Fairburn Rd SW",
"address_purpose": "LOCATION",
"city": "Atlanta",
"state": "GA",
"postal_code": "303314812",
"country_code": "US",
"telephone_number": "404-344-0618",
"fax_number": "404-344-7810",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "SHANNON",
"first_name": "ANGELA",
"middle_name": "P.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-11-16",
"last_updated": "2025-04-02",
"certification_date": "2025-04-02",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "GA",
"license": "036661",
"primary": false
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "CA",
"license": "C168597",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.