Healthcare Provider Details

I. General information

NPI: 1659364636
Provider Name (Legal Business Name): JOHN GREENE SHEPHERD PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 15TH ST CJ-1020
AUGUSTA GA
30912-0004
US

IV. Provider business mailing address

617 WOODWALK LN
MARTINEZ GA
30907-4939
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-4250
  • Fax:
Mailing address:
  • Phone: 706-364-9082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH 022206
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberRPH 022206
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: