Preston, Shade Raymond
Preston, Shade Raymond is an individual health care provider with primary practice located at 1350 Walton Way , Augusta GA 30901-2612. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Anesthesiology, Allopathic & Osteopathic Physicians / Pain Medicine. Allopathic & Osteopathic Physicians / Anesthesiology is his primary health care specialty. Preston, Shade Raymond can be contacted via phone (706) 737-9250.Contact Information
Primary practice address
1350 Walton Way
Augusta GA 30901-2612
Phone: (706) 737-9250
Fax: (706) 733-0697
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Anesthesiology | 207L00000X | 058811 | Georgia |
| Allopathic & Osteopathic Physicians / Pain Medicine | 207LP2900X | 058811 | Georgia |
Profile Details
| NPI number | 1053431635 |
|---|---|
| LBN Legal business name | Preston, Shade Raymond |
| Credentials | Doctor of Osteopathy (DO) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Mar 29th, 2007 |
| Last updated | Jun 16th, 2008 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1053431635 | NPPES |
| South Carolina | MEDICAID | G58811 | |
| South Carolina | Other | P00424799 | |
| South Carolina | MEDICAID | 159750664A |
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