DoctorDataHub
Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.

SHANNON WALLS

Active Sole Proprietor

SHANNON WALLS is a 125J00000X healthcare provider located in FORT BENNING, Georgia. NPI 1174276026 is currently active in the NPPES registry. Verify at CMS.

125J00000X · FORT BENNING, GA

Registration Details

NPI Number
1174276026
Provider Type
Individual
Gender
Female
NPI Issued
Feb 1, 2022 (4.5363287612801 yrs)
Last Updated
Jul 21, 2022
Sole Proprietor
Yes

Practice Information

Address
3255 11 AIRBORNE DIVISION ROAD
FORT BENNING, GA, 31801
Browse GA providers · Browse ZIP 31801
Phone
7065449071
Primary Specialty
125J00000X
125J00000X
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.