Provider Demographics
NPI:1700315512
Name:SHEAHAN, KERRY MARIE (DO)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:MARIE
Last Name:SHEAHAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 PHARR RD NE STE 605
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-3469
Mailing Address - Country:US
Mailing Address - Phone:404-919-9867
Mailing Address - Fax:
Practice Address - Street 1:550 PHARR RD NE STE 605
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-3469
Practice Address - Country:US
Practice Address - Phone:404-235-5982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-06
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA272274390200000X
GA914102084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program