Healthcare Provider Details

I. General information

NPI: 1497433502
Provider Name (Legal Business Name): SHELBY LYNN GELHAUS OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2023
Last Update Date: 08/09/2023
Certification Date: 08/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 JOHNSON FY RD NE BLDG 1
ATLANTA GA
30342-1709
US

IV. Provider business mailing address

3478 LAKESIDE DR NE UNIT 414
ATLANTA GA
30326-1855
US

V. Phone/Fax

Practice location:
  • Phone: 404-531-9988
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT003529
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: