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General NPI Number Information
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NPI Number | 1306500533
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Entity Type | Individual
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Provider Name | SHELLI DOUGLAS DC
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Gender | Female
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Dates
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Enumeration Date | 10/25/2021
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Last Update Date | 07/25/2022
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Provider Practice Location Address
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Address Line | 508 RIVERSIDE PKWY NE STE 300
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City | ROME
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State | GA
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Zip | 30161-2985
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Country | US
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Telephone | 404-904-5096
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Fax |
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Provider Business Mailing Address
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Address Line | 19 DEVONSHIRE DR SE
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City | ROME
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State | GA
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Zip | 30161-4062
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Country | US
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Telephone | 404-904-5096
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CHIR010642
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License Number State | GA
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