Provider Demographics
NPI:1780059261
Name:SHIVER, JEREMY CADE (PSYD)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:CADE
Last Name:SHIVER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1651 PHOENIX BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30349-5552
Mailing Address - Country:US
Mailing Address - Phone:770-997-1738
Mailing Address - Fax:770-991-1375
Practice Address - Street 1:1651 PHOENIX BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30349-5552
Practice Address - Country:US
Practice Address - Phone:770-997-1738
Practice Address - Fax:770-991-1375
Is Sole Proprietor?:No
Enumeration Date:2015-12-09
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003936103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical