Provider Demographics
NPI:1699756890
Name:SHY, JOE A (DO)
Entity type:Individual
Prefix:DR
First Name:JOE
Middle Name:A
Last Name:SHY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 CARRIAGE WAY SE
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-5503
Mailing Address - Country:US
Mailing Address - Phone:706-528-4136
Mailing Address - Fax:
Practice Address - Street 1:116 CARRIAGE WAY SE
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30161-5503
Practice Address - Country:US
Practice Address - Phone:706-528-4136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA60989207Q00000X, 207Q00000X
WV975207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA614523049AMedicaid
GA511I080360Medicare PIN
GA614523049AMedicaid