Provider Demographics
NPI:1225106941
Name:SHEPS, MARYANN CHRISTINE (DC, PA-C,CPT)
Entity Type:Individual
Prefix:DR
First Name:MARYANN
Middle Name:CHRISTINE
Last Name:SHEPS
Suffix:
Gender:F
Credentials:DC, PA-C,CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1499 WALTON WAY
Mailing Address - Street 2:SUITE 1400
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-2602
Mailing Address - Country:US
Mailing Address - Phone:706-724-6100
Mailing Address - Fax:
Practice Address - Street 1:1120 15TH ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912-0004
Practice Address - Country:US
Practice Address - Phone:706-724-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA453639363A00000X
GA7169363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4411-8578OtherCERTIFIED PHLEBOTOMY TECHNICIAN 1 LICENSE CERTIFICATION BY THE NHA
GA7169OtherGA PA LICENSE
CAPA18073OtherPA LICENSE 18073
CAA453639OtherLICENSE
GA7169OtherGA PA LICENSE
CAU36020Medicare UPIN