Healthcare Provider Details

I. General information

NPI: 1609874023
Provider Name (Legal Business Name): COURTNEY D SHELTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2005
Last Update Date: 12/14/2016
Certification Date:
Deactivation Date: 03/16/2006
Reactivation Date: 03/21/2006

III. Provider practice location address

315 BOULEVARD NE SUITE 310
ATLANTA GA
30312-1200
US

IV. Provider business mailing address

315 BOULEVARD NE SUITE 310
ATLANTA GA
30312-1200
US

V. Phone/Fax

Practice location:
  • Phone: 678-705-2355
  • Fax:
Mailing address:
  • Phone: 678-705-2355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number050559
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number050559
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: