Healthcare Provider Details

I. General information

NPI: 1992022719
Provider Name (Legal Business Name): ALICIA SHELLY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2010
Last Update Date: 10/31/2025
Certification Date: 10/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8820 HOSPITAL DR
DOUGLASVILLE GA
30134-2266
US

IV. Provider business mailing address

8820 HOSPITAL DR
DOUGLASVILLE GA
30134-2266
US

V. Phone/Fax

Practice location:
  • Phone: 770-947-3000
  • Fax: 770-947-3080
Mailing address:
  • Phone: 770-947-3000
  • Fax: 770-947-3080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number296213
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME137755
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA121267
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License Number69712
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number69712
License Number StateGA
# 6
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number69712
License Number StateGA
# 7
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101266249
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: