Healthcare Provider Details

I. General information

NPI: 1588647697
Provider Name (Legal Business Name): SHELDON MARSHALL SHORE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 03/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 COLLIER RD NW SUITE 290
ATLANTA GA
30309-1709
US

IV. Provider business mailing address

275 COLLIER RD NW SUITE 290
ATLANTA GA
30309-1709
US

V. Phone/Fax

Practice location:
  • Phone: 404-352-3300
  • Fax: 404-352-9453
Mailing address:
  • Phone: 404-352-3300
  • Fax: 404-352-9453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number048720
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: