Individual
DR. MYRA SHIVERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
118 N PARK DR, FAYETTEVILLE, GA 30214-1645
(770) 460-6765
(770) 460-5598
Mailing address
118 N PARK DR, FAYETTEVILLE, GA 30214-1645
(770) 460-6765
(770) 460-5598
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
9975
GA
Other
Enumeration date
04/18/2007
Last updated
07/08/2007
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