Active NPI
Stefanie Lee Shaver, M.D.
- Aerospace Medicine Physician
- Columbus, MS
National Provider Identifier
1093821019
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Aerospace Medicine Physician
- License
- 56647
- Practice address
- Koritz Clinic 201 Independence Drive
Columbus, MS 39710-7139 - Phone
- (662) 434-2292
- NPI assigned
- Aug 22, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sports Medicine (Family Medicine) Physician | 207QS0010X | 056647 | GA | |
| Military Health Care Provider | 171000000X | 56647 | GA | |
| Family Medicine Physician | 207Q00000X | 056647 | GA | |
| Aerospace Medicine Physician | 2083A0100X | 56647 | GA | Primary |
Addresses
Primary practice location
Koritz Clinic 201 Independence Drive
Columbus, MS 39710-7139
Mailing address
201 Independence Drive Koritz Clinic
Columbus, MS 39710-7594
Phone (404) 432-2724
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 802792298B | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 56647 | GA | MD | Military Health Care Provider |
| 056647 | GA | MD | Sports Medicine (Family Medicine) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156204800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1759104000000",
"number": "1093821019",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "201 INDEPENDENCE DRIVE KORITZ CLINIC",
"city": "COLUMBUS",
"state": "MS",
"postal_code": "397107594",
"telephone_number": "404-432-2724"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "KORITZ CLINIC 201 INDEPENDENCE DRIVE",
"city": "COLUMBUS",
"state": "MS",
"postal_code": "397107139",
"telephone_number": "662-434-2292"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAVER",
"first_name": "STEFANIE",
"middle_name": "LEE",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-22",
"last_updated": "2025-09-29",
"certification_date": "2025-09-29",
"status": "A"
},
"taxonomies": [
{
"code": "207QS0010X",
"taxonomy_group": "",
"desc": "Family Medicine, Sports Medicine",
"state": "GA",
"license": "056647",
"primary": false
},
{
"code": "171000000X",
"taxonomy_group": "",
"desc": "Military Health Care Provider",
"state": "GA",
"license": "56647",
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "GA",
"license": "056647",
"primary": false
},
{
"code": "2083A0100X",
"taxonomy_group": "",
"desc": "Preventive Medicine, Aerospace Medicine",
"state": "GA",
"license": "56647",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "802792298B",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Columbus, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.