Provider Demographics
NPI:1396242616
Name:SHOOPS, JARED W (MD)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:W
Last Name:SHOOPS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4025 JOHNS CREEK PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-5683
Mailing Address - Country:US
Mailing Address - Phone:404-575-4500
Mailing Address - Fax:404-575-4555
Practice Address - Street 1:4025 JOHNS CREEK PKWY STE 100
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-5683
Practice Address - Country:US
Practice Address - Phone:404-575-4500
Practice Address - Fax:404-575-4555
Is Sole Proprietor?:No
Enumeration Date:2018-04-12
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA100488207X00000X
MST-5111207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery