Provider Demographics
NPI:1508834516
Name:SHIDA, GEORGE DAVID (OD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:DAVID
Last Name:SHIDA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 ABERNATHY RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30328-2562
Mailing Address - Country:US
Mailing Address - Phone:404-252-1702
Mailing Address - Fax:404-303-8843
Practice Address - Street 1:901 ABERNATHY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-2562
Practice Address - Country:US
Practice Address - Phone:404-252-1702
Practice Address - Fax:404-303-8843
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT 000917152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA823239700AMedicaid
GA410348887AMedicaid
GA823239700AMedicaid
GA410348887AMedicaid