Provider Demographics
NPI:1295738722
Name:BARTON, SHANNON T
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:T
Last Name:BARTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 VENTURE COURT
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:GA
Mailing Address - Zip Code:31064
Mailing Address - Country:US
Mailing Address - Phone:706-468-7002
Mailing Address - Fax:706-468-7020
Practice Address - Street 1:545 VENTURE COURT
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:GA
Practice Address - Zip Code:31064
Practice Address - Country:US
Practice Address - Phone:706-468-7002
Practice Address - Fax:706-468-7020
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-30
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA048843207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000875025EMedicaid
GA048843OtherSTATE LICENSE
GAP00143999OtherRAILROAD MEDICARE
GA806988OtherBCBS
GAP00143999OtherRAILROAD MEDICARE
GAH20721Medicare UPIN