Provider Demographics
NPI:1134160468
Name:SHEDD, BOBBY JOEL (PA-C)
Entity type:Individual
Prefix:
First Name:BOBBY
Middle Name:JOEL
Last Name:SHEDD
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:JOEL
Other - Middle Name:
Other - Last Name:SHEDD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:236 HERMAN FLOYD RD
Mailing Address - Street 2:
Mailing Address - City:COCHRAN
Mailing Address - State:GA
Mailing Address - Zip Code:31014-2748
Mailing Address - Country:US
Mailing Address - Phone:782-983-6794
Mailing Address - Fax:
Practice Address - Street 1:179 W DYKES ST
Practice Address - Street 2:
Practice Address - City:COCHRAN
Practice Address - State:GA
Practice Address - Zip Code:31014-6921
Practice Address - Country:US
Practice Address - Phone:478-934-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA4486363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant