Provider Demographics
NPI:1720375538
Name:SHAVER, REBECCA PARKER (PA-C)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:PARKER
Last Name:SHAVER
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 1:455 SOUTH MAIN STREET
Mailing Address - Street 2:SUITE 104A
Mailing Address - City:HINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31313
Mailing Address - Country:US
Mailing Address - Phone:912-876-5644
Mailing Address - Fax:912-877-6341
Practice Address - Street 1:455 SOUTH MAIN STREET
Practice Address - Street 2:SUITE 104A
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313
Practice Address - Country:US
Practice Address - Phone:912-876-5644
Practice Address - Fax:912-877-6341
Is Sole Proprietor?:No
Enumeration Date:2011-06-30
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA6157363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant