Provider Demographics
NPI:1457420614
Name:SHIVERS, WILLIAM F JR (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:F
Last Name:SHIVERS
Suffix:JR
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 1:267 N HARRINGTON RD
Mailing Address - Street 2:
Mailing Address - City:ST SIMONS ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31522-5341
Mailing Address - Country:US
Mailing Address - Phone:912-230-0030
Mailing Address - Fax:912-634-0959
Practice Address - Street 1:267 N HARRINGTON RD
Practice Address - Street 2:
Practice Address - City:ST SIMONS ISLAND
Practice Address - State:GA
Practice Address - Zip Code:31522-5341
Practice Address - Country:US
Practice Address - Phone:912-230-0030
Practice Address - Fax:912-634-0959
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0302142084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA26BDJMQMedicare ID - Type Unspecified
GAD41106Medicare UPIN