Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 047840 | GA |
NPI | 1003986985 |
---|---|
Provider Name | Melinda E Shelton |
First Address | Decatur, GA 30030-2106 |
Second Address | Decatur, GA 30030-2106 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000932038A | (05) | GA |