Individual
DR. JOHN A SHIVDAT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1120 MORNINGSIDE DR, PERRY, GA 31069-2906
(478) 988-1706
(478) 988-1794
Mailing address
1074 GRAND OAKS GLN NW, MARIETTA, GA 30064-5423
(770) 424-0901
(727) 507-3618
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
25MB06152500
NJ
207P00000X
Emergency Medicine Physician
47527
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6848109
—
NJ
01
—
P00630321
MEDICARE RAILROAD
NJ
Enumeration date
05/26/2006
Last updated
03/03/2023
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