Provider Demographics
NPI:1003164468
Name:PALLIATIVE CARE CONSULTANTS OF SOUTHEAST GEORGIA, LLC
Entity Type:Organization
Organization Name:PALLIATIVE CARE CONSULTANTS OF SOUTHEAST GEORGIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:JOHN SHANER, MD
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHANER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-289-9200
Mailing Address - Street 1:1692 GLYNCO PARKWAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31525
Mailing Address - Country:US
Mailing Address - Phone:912-289-9200
Mailing Address - Fax:
Practice Address - Street 1:1692 GLYNCO PARKWAY
Practice Address - Street 2:SUITE 100
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31525
Practice Address - Country:US
Practice Address - Phone:912-289-9200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-16
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA065178207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Single Specialty