Provider Demographics
NPI:1114911930
Name:SHIVER, GERRIE MICHELLE (MD)
Entity Type:Individual
Prefix:
First Name:GERRIE
Middle Name:MICHELLE
Last Name:SHIVER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7200
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-0200
Mailing Address - Country:US
Mailing Address - Phone:252-937-0200
Mailing Address - Fax:252-451-0056
Practice Address - Street 1:901 N WINSTEAD AVE
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-8467
Practice Address - Country:US
Practice Address - Phone:252-937-0235
Practice Address - Fax:252-937-3102
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9601624207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC110128693OtherRAILROAD MEDICARE
NC69971OtherMEDCOST
NC1006FOtherBCBSNC
NC891006FMedicaid
NC6690602OtherCIGNA HEALTHCARE
NC69971OtherMEDCOST
NC891006FMedicaid