MEDICARE: BOBBY JOEL SHEDD PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	4486	GA

General Provider Information

NPI Number	:	1134160468
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BOBBY JOEL SHEDD PA-C

Provider Business Mailing Address
First Line	:	236 HERMAN FLOYD RD
Second Line	:
City	:	COCHRAN
State	:	GA
Zip	:	31014-2748
Country	:	US
Telephone Number	:	782-983-6794
Fax Number	:

Provider Business Practice Location Address
First Line	:	179 W DYKES ST
Second Line	:
City	:	COCHRAN
State	:	GA
Zip	:	31014-6921
Country	:	US
Telephone Number	:	478-934-8200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	02/07/2024

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