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General NPI Number Information
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NPI Number | 1811180607
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Entity Type | Individual
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Provider Name | PHESTON GRAY SHELTON IV M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/24/2007
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Last Update Date | 02/03/2021
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Provider Practice Location Address
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Address Line | 905 JOHNS HOPKINS DR
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City | GREENVILLE
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State | NC
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Zip | 27834-2056
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Country | US
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Telephone | 252-744-1406
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 751069
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City | CHARLOTTE
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State | NC
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Zip | 28275-1069
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Country | US
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Telephone |
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 2009-00479
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 2009-00479
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License Number State | NC
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