Provider Demographics
NPI:1386984755
Name:O'SHEA, JOHN STEWART (M D)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:STEWART
Last Name:O'SHEA
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:576 PELHAM RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-5105
Mailing Address - Country:US
Mailing Address - Phone:404-876-6170
Mailing Address - Fax:
Practice Address - Street 1:576 PELHAM RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-5105
Practice Address - Country:US
Practice Address - Phone:404-876-6170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-22
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA33169208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics