Healthcare Provider Details

I. General information

NPI: 1023748696
Provider Name (Legal Business Name): KHADIJA JONES-SHELTON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2022
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

527 EISENHOWER DR
SAVANNAH GA
31406-2668
US

IV. Provider business mailing address

527 EISENHOWER DR
SAVANNAH GA
31406-2668
US

V. Phone/Fax

Practice location:
  • Phone: 912-819-9100
  • Fax: 912-819-9101
Mailing address:
  • Phone: 912-819-9100
  • Fax: 912-819-9101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number109401
License Number StateGA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: