Healthcare Provider Details

I. General information

NPI: 1306400858
Provider Name (Legal Business Name): ANDREW DOUGLAS SHELDON MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2019
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3747 ROSWELL RD
MARIETTA GA
30062-6215
US

IV. Provider business mailing address

3747 ROSWELL RD
MARIETTA GA
30062-6215
US

V. Phone/Fax

Practice location:
  • Phone: 470-956-0250
  • Fax:
Mailing address:
  • Phone: 470-956-0250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number105324
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: