Individual
SHANE LEON GIDDENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
005490
GA
363A00000X
Physician Assistant
PA9103541
FL
363AS0400X
Surgical Physician Assistant
Primary
005490
GA
Other
Enumeration date
05/11/2007
Last updated
10/15/2020
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