Provider Demographics
NPI:1295841690
Name:CHARLES BRINSON SHIVER, III
Entity Type:Organization
Organization Name:CHARLES BRINSON SHIVER, III
Other - Org Name:CHARLES B SHIVER, III, MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BOBBIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-453-0662
Mailing Address - Street 1:641 W THOMAS ST
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-2337
Mailing Address - Country:US
Mailing Address - Phone:478-453-0662
Mailing Address - Fax:478-452-8067
Practice Address - Street 1:641 W THOMAS ST
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-2337
Practice Address - Country:US
Practice Address - Phone:478-453-0662
Practice Address - Fax:478-452-8067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA$$$$$$$$$OtherSSN
GA52237577OtherBCBS OF GA
GA11SCDBVMedicare ID - Type Unspecified
GA=========31061OtherCHAMPUS/TRICARE/TRICALIFE
GAH03836Medicare UPIN