Provider Demographics
NPI:1114400553
Name:DENISE Q SHEPARD
Entity Type:Organization
Organization Name:DENISE Q SHEPARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE
Authorized Official - Prefix:
Authorized Official - First Name:CANDY
Authorized Official - Middle Name:K
Authorized Official - Last Name:HOUSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-861-7166
Mailing Address - Street 1:1895 BATTLEFIELD PKWY
Mailing Address - Street 2:
Mailing Address - City:FORT OGLETHORPE
Mailing Address - State:GA
Mailing Address - Zip Code:30742-4021
Mailing Address - Country:US
Mailing Address - Phone:706-861-7166
Mailing Address - Fax:706-861-1799
Practice Address - Street 1:1895 BATTLEFIELD PKWY
Practice Address - Street 2:
Practice Address - City:FORT OGLETHORPE
Practice Address - State:GA
Practice Address - Zip Code:30742-4021
Practice Address - Country:US
Practice Address - Phone:706-861-7166
Practice Address - Fax:706-861-1799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-12
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty