Healthcare Provider Details

I. General information

NPI: 1396088720
Provider Name (Legal Business Name): NATALY DE LOS ANGELES SHILDT D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2013
Last Update Date: 08/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 JESSE HILL JR DR SE
ATLANTA GA
30303
US

IV. Provider business mailing address

670 EMERIL DR
DECATUR GA
30032-1195
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-1440
  • Fax:
Mailing address:
  • Phone: 904-403-7860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number76181
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number76181
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: