Healthcare Provider Details

I. General information

NPI: 1891717815
Provider Name (Legal Business Name): DOUGLAS A. SHIELDS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 05/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 HOSPITAL DR
SPRUCE PINE NC
28777-3035
US

IV. Provider business mailing address

PO BOX 98
JONAS RIDGE NC
28641-0098
US

V. Phone/Fax

Practice location:
  • Phone: 828-765-4201
  • Fax:
Mailing address:
  • Phone: 828-385-0915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberE4736
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: