Individual
DR. DONALD E SHACKLEFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1061 HARMON AVE, FORT STEWART, GA 31314
(912) 435-6965
Mailing address
1061 HARMON AVE,, FORT STEWART, GA 31314-5641
(912) 435-6965
(812) 842-4535
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
01068929A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
192890008
MEDICARE PTAN
IN
05
—
201003930
—
IN
05
—
64271570
—
KY
Enumeration date
05/27/2005
Last updated
06/11/2018
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