Provider Demographics
NPI:1972575777
Name:PHELPS, SHEAN ERIC (MD)
Entity Type:Individual
Prefix:DR
First Name:SHEAN
Middle Name:ERIC
Last Name:PHELPS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 COTTAGE AVE
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:AL
Mailing Address - Zip Code:36330-8552
Mailing Address - Country:US
Mailing Address - Phone:706-315-8742
Mailing Address - Fax:334-255-6959
Practice Address - Street 1:2 COTTAGE AVE
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330-8552
Practice Address - Country:US
Practice Address - Phone:706-315-8742
Practice Address - Fax:334-255-6959
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-06
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA045109207Q00000X, 2083A0100X
ALMD.28477207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAG94243Medicare UPIN