Provider Demographics
NPI:1417321688
Name:SHAY, DEVON
Entity Type:Individual
Prefix:
First Name:DEVON
Middle Name:
Last Name:SHAY
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 1:59 LIVE OAK RUN NW
Mailing Address - Street 2:NONE
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30121-9228
Mailing Address - Country:US
Mailing Address - Phone:770-733-0875
Mailing Address - Fax:770-345-4301
Practice Address - Street 1:59 LIVE OAK RUN NW
Practice Address - Street 2:NONE
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30121-9228
Practice Address - Country:US
Practice Address - Phone:770-733-0875
Practice Address - Fax:770-345-4301
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-25
Last Update Date:2015-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator