Provider Demographics
NPI:1851747893
Name:O'SHEA, JESSE GARRETT (MD, MSC)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:GARRETT
Last Name:O'SHEA
Suffix:
Gender:M
Credentials:MD, MSC
Other - Prefix:
Other - First Name:JESSE
Other - Middle Name:GARRETT
Other - Last Name:OSHEA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, MSC
Mailing Address - Street 1:2665 N DECATUR RD STE 330
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-6145
Mailing Address - Country:US
Mailing Address - Phone:404-297-9755
Mailing Address - Fax:
Practice Address - Street 1:2665 N DECATUR RD STE 330
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-6145
Practice Address - Country:US
Practice Address - Phone:404-297-9755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-09
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA83453207RI0200X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA83453OtherSTATE LICENSE