MEDICARE: SHELBY K BRANTLEY M.D.

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	208200000X	Plastic Surgery Physician	11700	MS
2	2082S0099X	Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician	11700	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679503023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELBY K BRANTLEY M.D.

Provider Business Mailing Address
First Line	:	1030 N FLOWOOD DR STE A
Second Line	:
City	:	FLOWOOD
State	:	MS
Zip	:	39232-9532
Country	:	US
Telephone Number	:	601-387-9005
Fax Number	:	601-387-9006

Provider Business Practice Location Address
First Line	:	1030 N FLOWOOD DR STE A
Second Line	:
City	:	FLOWOOD
State	:	MS
Zip	:	39232-9532
Country	:	US
Telephone Number	:	601-387-9005
Fax Number	:	601-387-9006

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

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	12/04/2025

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