Provider Demographics
NPI:1669814034
Name:SHEARER, GWENDOLYN LEIGHANN (PA-C)
Entity Type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:LEIGHANN
Last Name:SHEARER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 NORTHSIDE BLVD STE 2000
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-6205
Mailing Address - Country:US
Mailing Address - Phone:770-781-4010
Mailing Address - Fax:770-781-5334
Practice Address - Street 1:1340 UPPER HEMBREE RD
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-0927
Practice Address - Country:US
Practice Address - Phone:770-569-0777
Practice Address - Fax:770-569-7631
Is Sole Proprietor?:No
Enumeration Date:2013-07-25
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2510363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical