Provider Demographics
NPI:1710902820
Name:SHEARER, PATRICIA D (MD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:D
Last Name:SHEARER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1086 ARBOR TRCE NE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30319-5378
Mailing Address - Country:US
Mailing Address - Phone:404-986-8756
Mailing Address - Fax:404-986-0803
Practice Address - Street 1:1086 ARBOR TRCE NE
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30319-5378
Practice Address - Country:US
Practice Address - Phone:404-986-8756
Practice Address - Fax:404-986-0803
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA080510207RH0002X
GA80510208000000X, 2080P0207X, 2080H0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080H0002XAllopathic & Osteopathic PhysiciansPediatricsHospice and Palliative Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1430218Medicaid
FL277197700Medicaid
LA1430218Medicaid
FL277197700Medicaid
FLAD583YMedicare PIN
F30588Medicare UPIN