MEDICARE: SHIRLEY ANN BYRD

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	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care		GA
2	390200000X	Student in an Organized Health Care Education/Training Program		GA

General Provider Information

NPI Number	:	1689203952
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHIRLEY ANN BYRD

Provider Business Mailing Address
First Line	:	45 LAKE SHORE BLVD
Second Line	:
City	:	PORT WENTWORTH
State	:	GA
Zip	:	31407-3612
Country	:	US
Telephone Number	:	912-484-7573
Fax Number	:

Provider Business Practice Location Address
First Line	:	45 LAKE SHORE BLVD
Second Line	:
City	:	SAVANNAH
State	:	GA
Zip	:	31407-3612
Country	:	US
Telephone Number	:	912-484-7573
Fax Number	:

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

Provider Enumeration Date	:	04/07/2020
Last Update Date	:	04/07/2020

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Directions to “ SHIRLEY ANN BYRD ” Practice Location

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