Provider Demographics
NPI:1578746756
Name:ASHLEY E O'SHIELDS MD PC
Entity Type:Organization
Organization Name:ASHLEY E O'SHIELDS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:E
Authorized Official - Last Name:O'SHIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-429-9965
Mailing Address - Street 1:400 DAWSON COMMONS CIRCLE
Mailing Address - Street 2:SUITE 420
Mailing Address - City:DAWSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30534
Mailing Address - Country:US
Mailing Address - Phone:706-429-9965
Mailing Address - Fax:706-429-9967
Practice Address - Street 1:400 DAWSON COMMONS CIRCLE
Practice Address - Street 2:SUITE 420
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534
Practice Address - Country:US
Practice Address - Phone:706-429-9965
Practice Address - Fax:706-429-9967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-11
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA053508208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty