Individual
JACK P. SHEPHERD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
330 BILLINGSLEY RD STE 101, CHARLOTTE, NC 28211-5020
(704) 316-2333
(704) 316-2334
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
200201174
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
89132W1
—
NC
05
—
N01174
—
SC
Enumeration date
05/17/2006
Last updated
08/19/2021
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