Provider Demographics
NPI:1992764690
Name:SHIREY, NEAL DONALD (MD)
Entity type:Individual
Prefix:DR
First Name:NEAL
Middle Name:DONALD
Last Name:SHIREY
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 1:528 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224-4212
Mailing Address - Country:US
Mailing Address - Phone:678-902-4847
Mailing Address - Fax:770-415-1447
Practice Address - Street 1:528 S 8TH ST
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224-4212
Practice Address - Country:US
Practice Address - Phone:678-902-4847
Practice Address - Fax:770-415-1447
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0478422085R0204X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL148646Medicaid
GA402295615PMedicaid
AL148646Medicaid
GA202G707915Medicare PIN
GA202I304550Medicare PIN