Provider Demographics
NPI:1043386238
Name:SHIREY, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:SHIREY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4570 REESE RD
Mailing Address - Street 2:STE. D
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31907-1177
Mailing Address - Country:US
Mailing Address - Phone:706-563-7444
Mailing Address - Fax:706-563-7444
Practice Address - Street 1:4570 REESE RD
Practice Address - Street 2:STE. D
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31907-1177
Practice Address - Country:US
Practice Address - Phone:706-563-7444
Practice Address - Fax:706-563-7444
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC001697101YP2500X
GA001902363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant