MR. PHILLIP SHANNON FARRIS (NPI# 1104904903) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104904903 |
| Entity Type | Individual |
| Full Name | MR. PHILLIP SHANNON FARRIS |
| Credential | PA-C, MPAS. |
| Practice Address |
1103 16th Ave Se Decatur AL 35601-3595 |
| Mailing Address |
2404 11th St Se Decatur AL 35601-4598 |
| Practice Telephone | 2563500362 |
| Mailing Telephone | 2563532018 |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2009-04-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | PA-262 | AL | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AL | ALABAMA LICENSE NUMBER | PA-262 | 01 |
| Street Address |
1103 16TH AVE SE |
| City | DECATUR |
| State | AL |
| Zip Code | 35601-3595 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962036665 | Krista Butts | Nurse Practitioner | 1103 16th Ave Se, Decatur, AL 35601-3595 | 2020-03-03 |
| 1295240588 | Eric Todd Smith | Technician/Technologist | 1103 16th Ave Se, Decatur, AL 35601-3595 | 2017-12-07 |
| 1679095699 | Jeremy Keith Urban | Nurse Practitioner | 1103 16th Ave Se, Decatur, AL 35601 | 2017-07-11 |
| 1699169474 | Nicholas Krishnan | Physician Assistant | 1103 16th Ave Se, Decatur, AL 35601-3595 | 2015-03-19 |
| 1841633187 | Justin David Hallock | Orthopaedic Surgery | 1103 16th Ave Se, Decatur, AL 35601-3595 | 2013-04-16 |
| 1073854626 | Meghan Pace Hollimon | Nurse Practitioner | 1103 16th Ave Se, Decatur, AL 35601-3595 | 2013-03-06 |
| 1902045867 | Janice D Draper | Physical Therapist | 1103 16th Ave Se, Decatur, AL 35601-3595 | 2009-02-16 |
| 1215198007 | Justin L Daigre | Specialist | 1103 16th Ave Se, Decatur, AL 35601-3595 | 2008-06-24 |
| 1023234648 | Charles Edward Fortenberry | Nurse Practitioner | 1103 16th Ave Se, Decatur, AL 35601-3595 | 2007-04-18 |
| 1740331347 | Decatur Orthopaedic Clinic, LLC | Physical Medicine & Rehabilitation | 1103 16th Ave Se, Decatur, AL 35601-3595 | 2007-01-12 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376000679 | Monica Dawn Ross | Counselor | 106 Lee St. Ne, Suite C, Decatur, AL 35601 | 2019-02-23 |
| 1063950319 | Samantha Elizabeth Pickett | Nurse Practitioner | 1115 Beltline Rd Se, Ste 400, Decatur, AL 35601 | 2017-02-07 |
| 1497208250 | Beronica Goodwin | Home Health Aide | 1102b Suite #2 4th Ave Se, Decatur, AL 35601 | 2016-07-28 |
| 1770957177 | Xochitl Dupre | Obstetrics & Gynecology | 1874 Beltline Road Sw, Suite 105, Decatur, AL 35601 | 2015-11-23 |
| 1104224708 | River City Psychiatry, Inc. | Community/Behavioral Health | 115 Johnston Street, Se, Suite 202, Decatur, AL 35601 | 2014-12-12 |
| 1760882690 | Derrick Aaron Randolph | Registered Nurse | 1207 7th St S.e., Decatur/morgan Hospital - Parkway Campus, Decatur, GA 35601 | 2014-08-28 |
| 1427465434 | Martha Read | Family Medicine | 2208 Danville Rd Sw Ste A, Decatur, AL 35601 | 2014-07-22 |
| 1205242948 | Pure Heart Home Care of Alabama, LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 107 B 14th Street Sw, Decatur, AL 35601 | 2014-07-02 |
| 1720492242 | Christopher John Phillips | Emergency Medicine | 1201 7th Street Se, Decatur, AL 35601 | 2014-06-12 |
| 1366794711 | Complete Dental Decatur LLC | Dentist | 1241 Point Mallard Parkway, Suite. 105, Decatur, AL 35601 | 2012-10-10 |
| Find all providers in zip 35601 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598374860 | Lauren Nolan | Physician Assistant | 500 Irvin Ct # 200, Decatur, GA 30030-1705 | 2020-07-23 |
| 1134749930 | Elissa Stanton | Physician Assistant | 1280 Sanden Ferry Dr, Decatur, GA 30033-3346 | 2020-04-21 |
| 1902457138 | April Lynette Williams | Physician Assistant | 3669 Riverchase Ter, Decatur, GA 30034-4876 | 2019-09-29 |
| 1194389353 | Katherine Serafen | Physician Assistant | 2701 N Decatur Road, Ground Floor Suite 520, Decatur, GA 30033 | 2019-04-23 |
| 1124531249 | Carolina Espina | Physician Assistant | 2665 N Decatur Rd Ste 630, Decatur, GA 30033-6147 | 2017-11-10 |
| 1447703731 | Jessica Lin Brewer | Physician Assistant | 2186 Clairmont Rd, Decatur, GA 30033-1937 | 2016-08-03 |
| 1174972459 | Peter Bell | Physician Assistant | 2946 Clifton Springs Rd, Decatur, GA 30034-3820 | 2016-06-08 |
| 1902299597 | Farida Ahmadi | Physician Assistant | 200 E Ponce De Leon Ave Ste 110, Decatur, GA 30030-3467 | 2015-03-06 |
| 1730431313 | Daniel Lau | Physician Assistant | 2801 N. Decatur Road Suite 200, Decatur, GA 30033 | 2012-10-08 |
| 1720344302 | Kanwal Kapadia Lalani | Physician Assistant | 2665 N Decatur Rd Ste 430, Decatur, GA 30033-6145 | 2012-04-08 |
| Find all providers in DECATUR | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.