MEDICARE: DR. CONRAD WILLIAM SHEBELUT MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZH0000X	Hematology (Pathology) Physician	91228	GA

General Provider Information

NPI Number	:	1083111413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CONRAD WILLIAM SHEBELUT MD

Provider Business Mailing Address
First Line	:	1425 CRESCENT WALK
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30033-2402
Country	:	US
Telephone Number	:	559-269-0183
Fax Number	:

Provider Business Practice Location Address
First Line	:	2580 WESTSIDE PKWY
Second Line	:
City	:	ALPHARETTA
State	:	GA
Zip	:	30004-7426
Country	:	US
Telephone Number	:	678-248-8000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2018
Last Update Date	:	12/21/2024

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Directions to “ DR. CONRAD WILLIAM SHEBELUT MD” Practice Location

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