Provider Demographics
NPI:1730485509
Name:SHEFFIELD, HENRY RANDALL (DC)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:RANDALL
Last Name:SHEFFIELD
Suffix:
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:PO BOX 525
Mailing Address - Street 2:
Mailing Address - City:WILLACOOCHEE
Mailing Address - State:GA
Mailing Address - Zip Code:31650-0525
Mailing Address - Country:US
Mailing Address - Phone:912-422-4328
Mailing Address - Fax:
Practice Address - Street 1:410 WARD ST E
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-0001
Practice Address - Country:US
Practice Address - Phone:912-384-2608
Practice Address - Fax:912-383-8018
Is Sole Proprietor?:No
Enumeration Date:2011-01-26
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008686111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I350548Medicare PIN