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General NPI Number Information
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NPI Number | 1043257090
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Entity Type | Individual
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Provider Name | SHAYNE R SQUIRES M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/31/2006
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Last Update Date | 01/13/2020
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Provider Practice Location Address
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Address Line | 2151 W SPRING ST STE B110
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City | MONROE
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State | GA
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Zip | 30655-3209
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Country | US
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Telephone | 770-267-1895
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Fax |
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Provider Business Mailing Address
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Address Line | 2727 PACES FERRY RD SE STE 1-1100
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City | ATLANTA
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State | GA
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Zip | 30339-6151
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 62453
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 207U00000X
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Taxonomy Name | Nuclear Medicine Physician
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License Number | 34402
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License Number State | IA
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Taxonomy #3
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Taxonomy Code | 207U00000X
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Taxonomy Name | Nuclear Medicine Physician
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License Number | 223248
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License Number State | MA
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Taxonomy #4
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 77557
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License Number State | GA
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