MEDICARE: SHELTON SPORTS AND SPINE

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	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician
2	208VP0000X	Pain Medicine Physician
3	261QM2500X	Medical Specialty Clinic/Center	059870	GA

General Provider Information

NPI Number	:	1760874721
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHELTON SPORTS AND SPINE

Provider Business Mailing Address
First Line	:	4300 PLEASANT HILL RD STE A
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30096-6379
Country	:	US
Telephone Number	:	770-904-9602
Fax Number	:

Provider Business Practice Location Address
First Line	:	4300 PLEASANT HILL RD
Second Line	:	SUITE A
City	:	DULUTH
State	:	GEORGIA
Zip	:	30096
Country	:	US
Telephone Number	:	770-904-9602
Fax Number	:	678-401-0372

Authorized Official
Title or Position	:	FOUNDER
Name	:	DR. TIMOTHY SHELTON
Credential	:	M.D.
Telephone Number	:	770-904-9602

Provider Enumeration Date	:	03/01/2015
Last Update Date	:	10/28/2022

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Directions to “SHELTON SPORTS AND SPINE ” Practice Location

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