Provider Demographics
NPI:1912098450
Name:SHIREY, MARY SUZANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:SUZANNE
Last Name:SHIREY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:699A PIEDMONT AVE., NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308
Mailing Address - Country:US
Mailing Address - Phone:404-892-6465
Mailing Address - Fax:404-897-1697
Practice Address - Street 1:699A PIEDMONT AVE., NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308
Practice Address - Country:US
Practice Address - Phone:404-892-6465
Practice Address - Fax:404-897-1697
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA33452207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA33452OtherMEDICAL LICENSE
GABS2485945OtherDEA NUMBER
GABS2485945OtherDEA NUMBER
GA33452OtherMEDICAL LICENSE