Individual
GEORGE WILEY SHORTER III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH. D.
Contact information
Practice address
VAMC - UNIT 9 - 116B, 619 S. MARION AVE, LAKE CITY, FL 32025
(386) 755-3016
Mailing address
2217 DELLWOOD AVE, JACKSONVILLE, FL 32204-3101
(386) 755-3016
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
1244
AL
Other
Enumeration date
06/19/2006
Last updated
07/08/2007
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