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General NPI Number Information
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NPI Number | 1396937538
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Entity Type | Organization
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Legal Business Name | SHENARA AUSTIN SEXTON, MD, LLC
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Dates
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Enumeration Date | 08/13/2007
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Last Update Date | 08/13/2014
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Provider Practice Location Address
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Address Line | 1181 LANGFORD DR BLDG. 300, SUITE 103
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City | WATKINSVILLE
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State | GA
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Zip | 30677
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Country | US
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Telephone | 706-552-1226
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Fax | 706-552-1227
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Provider Business Mailing Address
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Address Line | 1181 LANGFORD DR BLDG. 300, SUITE 103
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City | WATKINSVILLE
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State | GA
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Zip | 30677
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Country | US
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Telephone | 706-552-1226
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Fax | 706-552-1227
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. SHENARA AUSTIN SEXTON
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Credential | M.D.
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Telephone | 706-552-1226
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 053161
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License Number State | GA
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