Provider Demographics
NPI:1053588731
Name:SHEPARD, DAVID DOUGLAS (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:DOUGLAS
Last Name:SHEPARD
Suffix:
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 1:2675 N DECATUR RD STE 200
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-6132
Mailing Address - Country:US
Mailing Address - Phone:404-501-7040
Mailing Address - Fax:404-501-7644
Practice Address - Street 1:2675 N DECATUR RD STE 200
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-6132
Practice Address - Country:US
Practice Address - Phone:404-501-7040
Practice Address - Fax:404-501-7644
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-13
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA66068174400000X
GA066068207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1053588731OtherNPI NUMBER