Provider Demographics
NPI:1184650988
Name:SHEPARD, DENISE Q (OD)
Entity Type:Individual
Prefix:DR
First Name:DENISE
Middle Name:Q
Last Name:SHEPARD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1895 BATTLEFIELD PKWY
Mailing Address - Street 2:
Mailing Address - City:FT 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:FT 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
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA893152W00000X
TN735152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN000173788Medicaid
GA00394677AMedicaid
GA00394677AMedicaid
TN000173788Medicaid
GA41ZCDNJMedicare ID - Type Unspecified