Provider Demographics
NPI:1134490048
Name:SHEPHERD RESOURCES
Entity Type:Organization
Organization Name:SHEPHERD RESOURCES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WOODROW
Authorized Official - Middle Name:W
Authorized Official - Last Name:SHEPHERD
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:706-734-2003
Mailing Address - Street 1:701 ALLGOOD ST
Mailing Address - Street 2:
Mailing Address - City:TRION
Mailing Address - State:GA
Mailing Address - Zip Code:30753-1357
Mailing Address - Country:US
Mailing Address - Phone:706-734-2003
Mailing Address - Fax:706-734-2099
Practice Address - Street 1:701 ALLGOOD ST
Practice Address - Street 2:
Practice Address - City:TRION
Practice Address - State:GA
Practice Address - Zip Code:30753-1357
Practice Address - Country:US
Practice Address - Phone:706-734-2003
Practice Address - Fax:706-734-2099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-24
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0234103261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center