NPIMap

Individual provider Active NPI

Andrea Shannon, D.C.

  • Chiropractor
  • Stockbridge, GA
National Provider Identifier
1659716355
Registry record updated Jul 15, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CHIR009319 Issued in GA
Practice address
5430 N Henry Blvd Ste 100
Stockbridge, GA 30281-3270
Phone
(770) 389-4744
NPI assigned
May 8, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 0104556985 VA
Chiropractor 111N00000X CHIR009319 GA Primary

Addresses

Primary practice location

5430 N Henry Blvd Ste 100
Stockbridge, GA 30281-3270

Mailing address

5430 N Henry Blvd Ste 100
Stockbridge, GA 30281-3270
Phone (770) 389-4744

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

State licenses

LicenseStateTypeSpecialty
CHIR009319GAMDChiropractor
0104556985VAMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Glame Chiropractic, Inc Chiropractor 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.

NPI Registry JSON

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

{
    "created_epoch": "1367971200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1405382400000",
    "number": "1659716355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5430 N HENRY BLVD STE 100",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302813270",
            "telephone_number": "770-389-4744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5430 N HENRY BLVD STE 100",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302813270",
            "telephone_number": "770-389-4744"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHANNON",
        "first_name": "ANDREA",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-05-08",
        "last_updated": "2014-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "VA",
            "license": "0104556985",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "GA",
            "license": "CHIR009319",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stockbridge, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2014; 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.