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General NPI Number Information
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NPI Number | 1730405069
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Entity Type | Organization
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Legal Business Name | SHAVER MEDICAL, PC
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Dates
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Enumeration Date | 04/12/2010
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Last Update Date | 04/14/2010
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Provider Practice Location Address
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Address Line | 980 E MAIN ST SUITE #300
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City | BLUE RIDGE
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State | GA
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Zip | 30513-7139
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Country | US
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Telephone | 706-632-5454
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Fax | 706-632-5451
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Provider Business Mailing Address
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Address Line | 980 E MAIN ST SUITE #300
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City | BLUE RIDGE
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State | GA
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Zip | 30513-7139
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Country | US
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Telephone | 706-632-5454
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Fax | 706-632-5451
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Authorized Official
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Title or Position | OWNER
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Name | STEFANIE L SHAVER
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Credential | MD
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Telephone | 706-632-5454
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 056647
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 056647
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License Number State | GA
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