Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | C54631 | CA |
Y | 2080P0203X | Pediatric Critical Care Doctor | 74590 | GA |
N | 2080P0203X | Pediatric Critical Care Doctor | C54631 | CA |
NPI | 1063485779 |
---|---|
Provider Name | Dr. David Kenneth Shellington |
First Address | Alpharetta, GA 30022-6408 |
Second Address | Alpharetta, GA 30022-6408 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2006 |
Last Update Date | 24/04/2017 |