Healthcare Provider Details

I. General information

NPI: 1700315512
Provider Name (Legal Business Name): KERRY MARIE SHEAHAN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2017
Last Update Date: 07/06/2023
Certification Date: 07/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 PHARR RD NE STE 605
ATLANTA GA
30305-3469
US

IV. Provider business mailing address

550 PHARR RD NE STE 605
ATLANTA GA
30305-3469
US

V. Phone/Fax

Practice location:
  • Phone: 404-235-5982
  • Fax:
Mailing address:
  • Phone: 404-919-9867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number272274
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number91410
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: