Individual
GLENN CLINTON SHEDD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
330 HAWTHORNE LN, ATHENS, GA 30606-2152
(706) 613-8500
(706) 613-8844
Mailing address
PO BOX 603725, CHARLOTTE, NC 28260-3725
(828) 575-2625
(828) 350-2174
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN117525
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000804427B
—
GA
01
—
202I507833
MEDICARE PTAN
GA
Enumeration date
09/20/2005
Last updated
10/18/2023
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