1053685826 NPI number — DR. GREGORY SCOTT SHEPHERD D.C.

Table of content: DR. GREGORY SCOTT SHEPHERD D.C. (NPI 1053685826)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053685826 NPI number — DR. GREGORY SCOTT SHEPHERD D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHEPHERD
Provider First Name:
GREGORY
Provider Middle Name:
SCOTT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053685826
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/18/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1737
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HIRAM
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30141-1737
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7951 VILLA RICA HWY STE 129
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30157-8668
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-952-6249
Provider Business Practice Location Address Fax Number:
603-590-6857
Provider Enumeration Date:
02/26/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CHIR008404 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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