Individual
BRYAN SHIVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
2501 N PATTERSON ST, VALDOSTA, GA 31602-0000
(229) 333-1000
Mailing address
PO BOX 402059, ATLANTA, GA 30384-2059
(229) 333-1000
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
003881
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
291857900
—
FL
05
—
856383907B
—
GA
Enumeration date
03/14/2006
Last updated
12/09/2008
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