Individual
SHAYNE R SQUIRES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2151 W SPRING ST STE B110, MONROE, GA 30655-3209
(770) 267-1895
Mailing address
2727 PACES FERRY RD SE STE 1-1100, ATLANTA, GA 30339-6151
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
62453
WI
207RC0000X
Cardiovascular Disease Physician
Primary
77557
GA
207U00000X
Nuclear Medicine Physician
223248
MA
207U00000X
Nuclear Medicine Physician
34402
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1043257090
—
IA
Enumeration date
05/31/2006
Last updated
01/13/2020
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