Provider Demographics
NPI:1386615573
Name:SHAVER, MARLA LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:MARLA
Middle Name:LYNN
Last Name:SHAVER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 MORRIS DR
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31719-8247
Mailing Address - Country:US
Mailing Address - Phone:229-928-3402
Mailing Address - Fax:229-928-3492
Practice Address - Street 1:410 MORRIS DR
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31719-8247
Practice Address - Country:US
Practice Address - Phone:229-928-3402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0556432085R0202X
CAG721242085R0202X
FLME968182085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH34591Medicare UPIN