Provider Demographics
NPI:1619141454
Name:SHEA, GERARD E JR (DC)
Entity Type:Individual
Prefix:DR
First Name:GERARD
Middle Name:E
Last Name:SHEA
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 DOUTHIT FERRY RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-4085
Mailing Address - Country:US
Mailing Address - Phone:770-387-3161
Mailing Address - Fax:770-387-3162
Practice Address - Street 1:680 DOUTHIT FERRY RD
Practice Address - Street 2:SUITE 103
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-4085
Practice Address - Country:US
Practice Address - Phone:770-387-3161
Practice Address - Fax:770-387-3162
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006781111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor