Organization
SOUTHERN INTERNAL MEDICINE CRITICAL CARE ASSOCIATES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH R SHAVER M.D. (OWNER)
(706) 339-5092
Entity
Organization
Contact information
Practice address
3614 J DEWEY GRAY CIR, BULDING B, AUGUSTA, GA 30909-6602
(706) 504-4651
(706) 504-4639
Mailing address
PO BOX 6750, AUGUSTA, GA 30916-6750
(706) 504-4651
(706) 504-4639
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
042430
GA
207RP1001X
Pulmonary Disease Physician
042430
GA
Other
Enumeration date
03/27/2015
Last updated
03/27/2015
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