Provider Demographics
NPI:1265829907
Name:SHEATS, DEREK SCOTT
Entity Type:Individual
Prefix:MR
First Name:DEREK
Middle Name:SCOTT
Last Name:SHEATS
Suffix:
Gender:M
Credentials:
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 116
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35602-0116
Mailing Address - Country:US
Mailing Address - Phone:256-642-3843
Mailing Address - Fax:256-686-0363
Practice Address - Street 1:146 ALSBROOKS DR
Practice Address - Street 2:
Practice Address - City:HARTSELLE
Practice Address - State:AL
Practice Address - Zip Code:35640-5732
Practice Address - Country:US
Practice Address - Phone:256-642-3843
Practice Address - Fax:256-686-0363
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-21
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker