Provider Demographics
NPI:1396372389
Name:SHUMATE, JOHN J III (MED, CSAC)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:J
Last Name:SHUMATE
Suffix:III
Gender:M
Credentials:MED, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:922 W SOUTH BLVD
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23805-1924
Mailing Address - Country:US
Mailing Address - Phone:804-835-2306
Mailing Address - Fax:
Practice Address - Street 1:9609 JEFFERSON DAVIS HWY
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23237-4621
Practice Address - Country:US
Practice Address - Phone:804-275-1116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-27
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0710102653101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty