GEORGE WILEY SHORTER III (NPI# 1295770535) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1295770535 |
| Entity Type | Individual |
| Full Name | GEORGE WILEY SHORTER III |
| Credential | PH. D. |
| Practice Address |
Vamc - Unit 9 - 116b 619 S. Marion Ave Lake City FL 32025 |
| Mailing Address |
2217 Dellwood Ave Jacksonville FL 32204-3101 |
| Practice Telephone | 3867553016 |
| Mailing Telephone | 3867553016 |
| Enumeration Date | 2006-06-19 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
1244 | AL | Behavioral Health & Social Service Providers |
| Street Address |
VAMC - UNIT 9 - 116B 619 S. MARION AVE |
| City | LAKE CITY |
| State | FL |
| Zip Code | 32025 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801438353 | Jennifer Bennett | Pharmacist | 347 Sw Main Blvd Suite 102, Lake City, FL 32025 | 2019-10-16 |
| 1700352838 | Robert J Sansouci IIi IIi | Physical Therapy Assistant | 560 Sw Mcfarlane Ave, Lake City, Fl, 32025, Lake City, FL 32025 | 2018-10-16 |
| 1316442783 | Emily Bailey | Developmental Therapist | 2126 Sw Sisters Welcome Rd, Lake City, FL 32025 | 2018-03-28 |
| 1811446370 | Michelle Hart | Behavioral Analyst | 260 S. Marion Avenue, Bldg. A, Suite 135, Lake City, FL 32025 | 2016-09-26 |
| 1922467646 | Irene Aponte Moreno | Nurse Practitioner | 440 Sw Perimeter Glen, Lake City, FL 32025 | 2016-02-23 |
| 1093186777 | Decarlos Scippio | Counselor | 619 Sw Baya Drive Suite 102, Lake City, FL 32025 | 2015-10-07 |
| 1497132476 | Jamecia Legree | Registered Nurse | 800 Sw Symphony Loop, Bldg 15 Apt 204, Lake City, FL 32025 | 2015-04-29 |
| 1306249149 | Mercy Home Assisted Living Facility LLC | Assisted Living Facility | 184 S.e. Beech Street, Lake City, FL 32025 | 2014-10-08 |
| 1598174344 | Karen Mcdonald | Developmental Therapist | 4523 Se County Road 252, Lake City, FL 32025 | 2014-08-06 |
| 1275944126 | Mohammad Ali Faisal Mdpa | Specialist | 1283 Sw State Rd 47, Ste 104, Lake City, FL 32025 | 2014-05-14 |
| Find all providers in zip 32025 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568677276 | Julia Cade Tesch | Psychologist | 619 S Marion Ave # 116b, Lake City, FL 32025-5808 | 2007-05-14 |
| 1639384761 | Cofa, LLC | Psychologist | 106 E Thomas St, Lake City, SC 29560-2639 | 2007-05-11 |
| 1275746190 | Jonathan D Cohen | Psychologist | 1188 Sw Main Blvd Ste 1, Lake City, FL 32025-6684 | 2007-05-07 |
| 1114935830 | Melanie M Nelson | Psychologist | 871 Sw State Road 47, Lake City, FL 32025-0433 | 2006-08-05 |
| 1518243344 | Mary Elizabeth Hammons | Psychologist | 619 S Marion Ave, 11-ca, Lake City, FL 32025-5808 | 2011-10-25 |
| 1902059801 | Serenity Psychological Services Inc | Psychologist | 560 Sw Mcfarlane Ave, Lake City, FL 32025 | 2008-10-23 |
| 1649461963 | Community Organized for Advancement, Inc. | Psychologist | 106 E Thomas St, Lake City, SC 29560-2639 | 2007-08-05 |
| 1699862011 | Gavin D Shoal | Psychologist | 619 S Marion Ave, Unit 9, Lake City, FL 32025-5808 | 2006-10-06 |
| 1285658385 | Blaze Harkey | Psychologist | 619 S Marion Ave, Va Medical Center, Lake City, FL 32025-5808 | 2006-07-26 |
| 1912938622 | John S. Auerbach | Psychologist | 619 S Marion Ave, Lake City, FL 32025-5808 | 2006-07-05 |
| Find all providers in LAKE CITY | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.