Healthcare Provider Details

I. General information

NPI: 1063485779
Provider Name (Legal Business Name): DAVID KENNETH SHELLINGTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2006
Last Update Date: 04/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3915 GREY ABBEY DR
ALPHARETTA GA
30022-6408
US

IV. Provider business mailing address

3915 GREY ABBEY DR
ALPHARETTA GA
30022-6408
US

V. Phone/Fax

Practice location:
  • Phone: 757-270-8880
  • Fax:
Mailing address:
  • Phone: 757-270-8880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC54631
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberC54631
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number74590
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: