Healthcare Provider Details

I. General information

NPI: 1710902820
Provider Name (Legal Business Name): PATRICIA D SHEARER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 09/24/2021
Certification Date: 09/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1086 ARBOR TRCE NE
BROOKHAVEN GA
30319-5378
US

IV. Provider business mailing address

1086 ARBOR TRCE NE
BROOKHAVEN GA
30319-5378
US

V. Phone/Fax

Practice location:
  • Phone: 404-986-8756
  • Fax: 404-986-0803
Mailing address:
  • Phone: 404-986-8756
  • Fax: 404-986-0803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number80510
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number80510
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number080510
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code2080H0002X
TaxonomyPediatric Hospice and Palliative Medicine Physician
License Number80510
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: