Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 062771 | GA |
Y | 111NI0900X | Internist | 062771 | GA |
N | 207R00000X | Internist | 22570 | SC |
N | 111NI0900X | Internist | 22570 | SC |
N | 207R00000X | Internist | 264368 | MA |
N | 111NI0900X | Internist | 264368 | MA |
N | 207RH0002X | Hospice and Palliative Medicine | 264368 | MA |
NPI | 1104895374 |
---|---|
Provider Name | Martin R Sheldon |
First Address | Swainsboro, GA 30401-3530 |
Second Address | Swainsboro, GA 30401-3530 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2006 |
Last Update Date | 03/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110104289A | (05) | MA |
225704 | (05) | SC |
869000211F | (05) | GA |