| Doctor Name: | MR. GERALD SHEPARD |
| NPI Number: | 1184099947 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | CACI |
| License Number: | 3114 |
| Business Practice Address: | 180 Water Oak Dr Cedartown, GA - 301252095 |
| Business Phone Number: | 7707482225 |
| Business Fax Number: | |
| Mailing Address: | 269 Kiker St, TALLAPOOSA |
| State: | GA |
| Postal Code: | 301761340 |
| Phone Number: | 4048097139 |
| Fax Number: | |
| NPI Enumeration Date: | 12/04/2015 |
| NPI Last Update Date: | 12/04/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 3114 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |