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NPI Code Detail

MEDICARE: DAVID JAMES SHAVER

MEDICARE: DAVID JAMES SHAVER
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
1390200000XStudent in an Organized Health Care Education/Training Program
21223G0001XGeneral Practice DentistryDN123834GA

General Provider Information

NPI Number : 1851190953
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID JAMES SHAVER
Provider Business Mailing Address
First Line : 299 N HIGHLAND AVE NE UNIT 4040
Second Line :
City : ATLANTA
State : GA
Zip : 30307-5643
Country : US
Telephone Number : 404-452-1811
Fax Number :
Provider Business Practice Location Address
First Line : 4458 JONESBORO RD
Second Line :
City : FOREST PARK
State : GA
Zip : 30297-4314
Country : US
Telephone Number : 470-878-3512
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/11/2025
Last Update Date : 07/23/2025

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