George Wiley Shorter III, PH. D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

1244 Issued in AL

Practice address

Vamc - Unit 9 - 116B
619 S. Marion Ave
Lake City, FL 32025

Phone

(386) 755-3016

NPI assigned

Jun 19, 2006

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

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1150675200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1295770535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2217 DELLWOOD AVE",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322043101",
            "telephone_number": "386-755-3016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "VAMC - UNIT 9 - 116B",
            "address_2": "619 S. MARION AVE",
            "city": "LAKE CITY",
            "state": "FL",
            "postal_code": "32025",
            "telephone_number": "386-755-3016"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHORTER",
        "first_name": "GEORGE",
        "middle_name": "WILEY",
        "name_suffix": "III",
        "credential": "PH. D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "AL",
            "license": "1244",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eva Sheppard
• Troy L Sheppard
• John Ronald Sherman, PTA
• Mary Shimko, CRNA
• Gavin D Shoal, PH.D.
• Jessica Shotwell, ARNP
• Taylor Sikes, MPH, RDN
• Myrna Silva
• Silver Leaf Therapy LLC
• Dean Silverberg, DO

• Clinical Psychologist in Lake City, FL
• Providers in Lake City, FL by specialty
• Clinical Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.