Provider Demographics
NPI:1144483736
Name:ROBERTSON, SHANNON CODY
Entity type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:CODY
Last Name:ROBERTSON
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 1:10 LEE ROAD 546
Mailing Address - Street 2:
Mailing Address - City:SMITHS
Mailing Address - State:AL
Mailing Address - Zip Code:36877-4624
Mailing Address - Country:US
Mailing Address - Phone:706-317-5001
Mailing Address - Fax:706-317-5004
Practice Address - Street 1:10 LEE ROAD 546
Practice Address - Street 2:
Practice Address - City:SMITHS
Practice Address - State:AL
Practice Address - Zip Code:36877-4624
Practice Address - Country:US
Practice Address - Phone:706-317-5001
Practice Address - Fax:706-317-5004
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health