Provider Demographics
NPI:1295788529
Name:SHIELDS, JAMES G JR (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:G
Last Name:SHIELDS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:705 WELLS RD STE 300
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-2982
Mailing Address - Country:US
Mailing Address - Phone:904-282-6331
Mailing Address - Fax:904-212-1351
Practice Address - Street 1:1865 LIME ST STE 101
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-4779
Practice Address - Country:US
Practice Address - Phone:904-321-2422
Practice Address - Fax:904-321-2434
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA027911207LP2900X
GA27911208VP0014X
FLME134552207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
JF010ZOtherMEDICARE
FL023177600Medicaid
GA20205I1334Medicare PIN
GAD41103Medicare UPIN