Provider Demographics
NPI:1982451126
Name:SHEARER, DYLAN (PA)
Entity type:Individual
Prefix:MR
First Name:DYLAN
Middle Name:
Last Name:SHEARER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 PEACHTREE INDUSTRIAL BLVD STE 4101
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-4542
Mailing Address - Country:US
Mailing Address - Phone:770-831-5525
Mailing Address - Fax:
Practice Address - Street 1:1300 PEACHTREE INDUSTRIAL BLVD STE 4101
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-4542
Practice Address - Country:US
Practice Address - Phone:770-831-5525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-06
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA363A00000X
GA12419363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant