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General NPI Number Information
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NPI Number | 1851747893
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Entity Type | Individual
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Provider Name | JESSE GARRETT O'SHEA M.D., MSC
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Gender | Male
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Dates
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Enumeration Date | 05/09/2016
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Last Update Date | 05/09/2022
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Provider Practice Location Address
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Address Line | 2665 N DECATUR RD STE 330
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City | DECATUR
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State | GA
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Zip | 30033-6145
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Country | US
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Telephone | 404-297-9755
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Fax |
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Provider Business Mailing Address
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Address Line | 2665 N DECATUR RD STE 330
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City | DECATUR
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State | GA
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Zip | 30033-6145
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Country | US
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Telephone | 404-297-9755
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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 | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | 83453
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License Number State | GA
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