MEDICARE: CHILTON SHELBY SUGERY, LLC

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	208600000X	Surgery Physician	00018919	AL

General Provider Information

NPI Number	:	1447466784
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHILTON SHELBY SUGERY, LLC

Provider Business Mailing Address
First Line	:	PO BOX 1604
Second Line	:
City	:	PELHAM
State	:	AL
Zip	:	35124-5604
Country	:	US
Telephone Number	:	205-280-7700
Fax Number	:	205-280-7088

Provider Business Practice Location Address
First Line	:	150 HEALTH CENTER DR
Second Line	:
City	:	CLANTON
State	:	AL
Zip	:	35045-2368
Country	:	US
Telephone Number	:	205-280-7700
Fax Number	:	205-280-7088

Authorized Official
Title or Position	:	MD
Name	:	RAGHAVACHARI SUNDER KRISHNAN
Credential	:	MD
Telephone Number	:	205-280-7700

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	08/22/2020

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