Gerald Shepard, CACI

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

3114 Issued in GA

Practice address

180 Water Oak Dr
Cedartown, GA 30125-2095

Phone

(770) 748-2225

NPI assigned

Dec 4, 2015

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Highland Rivers CSB

  • Community/Behavioral Health Agency
  • Cedartown, GA
  • NPI 1689737033
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1449187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1449187200000",
    "number": "1184099947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "269 KIKER ST",
            "city": "TALLAPOOSA",
            "state": "GA",
            "postal_code": "301761340",
            "telephone_number": "404-809-7139"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "180 WATER OAK DR",
            "city": "CEDARTOWN",
            "state": "GA",
            "postal_code": "301252095",
            "telephone_number": "770-748-2225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHEPARD",
        "first_name": "GERALD",
        "name_prefix": "Mr.",
        "credential": "CACI",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-12-04",
        "last_updated": "2015-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "GA",
            "license": "3114",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Yackinneia Roland, MA
• Norberto Rosado, MD
• Charis Hope Rudeseal, PHARMD
• Emalyn Samalio San Miguel
• Kisa W Seymore, MD
• Sherri Asbel
• Richard Leo Shortt Jr., D.C.
• Tony Simmons Jr.
• Cynthia Lynn Singleton, NP-C
• Calvin Louis Sinkfield

• Addiction (Substance Use Disorder) Counselor in Cedartown, GA
• Providers in Cedartown, GA by specialty
• Addiction (Substance Use Disorder) Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.