Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 043479 | GA |
NPI | 1053414458 |
---|---|
Provider Name | Scott W Shelfo |
First Address | Peachtree City, GA 30269-1378 |
Second Address | Newnan, GA 30265-8001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2006 |
Last Update Date | 28/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000758788C | (05) | GA |
340013925 | RAILROAD MEDICARE (01) | GA |
BS5324239 | DEA (01) | |
G54830 | (02) |