MEDICARE: MRS. CAROL FEDOR SHELLABARGER P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	002125	GA

General Provider Information

NPI Number	:	1376644088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CAROL FEDOR SHELLABARGER P.A.

Provider Business Mailing Address
First Line	:	3376 ARBOR RIDGE CT.
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30340
Country	:	US
Telephone Number	:	404-256-0775
Fax Number	:	404-459-8426

Provider Business Practice Location Address
First Line	:	3376 ARBOR RIDGE CT.
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30340
Country	:	US
Telephone Number	:	770-491-6276
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	01/12/2010

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