SHELTON SPORTS AND SPINE (NPI# 1760874721) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760874721 |
| Entity Type | Organization |
| Organization Name | SHELTON SPORTS AND SPINE |
| Practice Address |
1600 Kennesaw Due West Rd Nw Suite 501 Kennesaw GA 30152-4301 |
| Practice Telephone | 7709049602 |
| Practice Fax Number | 6784010372 |
| Mailing Telephone | 7709049602 |
| Mailing Fax Number | 6784010372 |
| Enumeration Date | 2015-03-01 |
| Last Update Date | 2015-03-01 |
| Authorized Official Name | DR. TIMOTHY SHELTON (FOUNDER) |
| Authorized Official Telephone | 7709049602 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM2500X |
Clinic/Center Specialization: Medical Specialty |
059870 | GA | Ambulatory Health Care Facilities |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Connecticut Business Registrations | SHELTON SPORTS AND SPINE P.C. | 110 Valleyview Place, Fairfield, CT 06824 |
| Street Address |
1600 KENNESAW DUE WEST RD NW SUITE 501 |
| City | KENNESAW |
| State | GA |
| Zip Code | 30152-4301 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215976394 | John Palmer Lanier | Physical Medicine & Rehabilitation | 1600 Kennesaw Due West Rd Nw, Suite 501, Kennesaw, GA 30152-4301 | 2006-06-05 |
| 1013373711 | Adam Fackler | Chiropractor | 1600 Kennesaw Due West Rd Nw, Kennesaw, GA 30152-4301 | 2016-01-11 |
| 1003212259 | Hallmark Dental, LLC | Dentist | 1600 Kennesaw Due West Rd Nw, 305-306, Kennesaw, GA 30152-4301 | 2014-11-17 |
| 1275819088 | Due West Integrated Health Center Physical Medicine, LLC | Physical Medicine & Rehabilitation | 1600 Kennesaw Due West Rd Nw, Suite 501, Kennesaw, GA 30152-4301 | 2011-10-25 |
| 1235378324 | Kennesaw Mountain Medical Group | Clinic/Center | 1600 Kennesaw Due West Rd Nw, Building 600 Suite 625, Kennesaw, GA 30152-4301 | 2009-02-12 |
| 1659528149 | Joseph N Grise | Chiropractor | 1600 Kennesaw Due West Rd Nw, Ste 501, Kennesaw, GA 30152-4301 | 2008-08-26 |
| 1669639373 | Park Robert Mitchell, M.d. | Obstetrics & Gynecology | 1600 Kennesaw Due West Rd Nw, Ste 620, Kennesaw, GA 30152-4301 | 2008-05-20 |
| 1619049954 | Park Robert Mitchell | Obstetrics & Gynecology | 1600 Kennesaw Due West Rd Nw, Ste 620, Kennesaw, GA 30152-4301 | 2006-11-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821647124 | Ashley Dover | Nurse Practitioner | 1300 Ridenour Blvd, Suite 300, Kennesaw, GA 30152 | 2019-09-09 |
| 1205306891 | Lashanda Denise Moore | Nurse Practitioner | 1600 Kennesaw Due West Rd Nw #205, Kennesaw, GA 30152 | 2018-11-27 |
| 1265901094 | Focused Loving Home Care Services LLC | In Home Supportive Care | 2151 Marne Glen Nw, Kennesaw, GA 30152 | 2018-11-22 |
| 1083199152 | Raven Ashley Thomas | Behavioral Analyst | 1619 Collins Rd Nw Ste 500, Kennesaw, GA 30152 | 2018-09-25 |
| 1821592593 | Eseovhe Egborge PC | Clinic/Center | 1600 Kennesaw Due West Rd Nw Ste 205, Kennesaw, GA 30152 | 2018-03-19 |
| 1184143059 | Kennesaw Mountain Dental Associates | Dentist | 1815 Old 41 Hwy, Ste 310, Kennesaw, GA 30152 | 2017-09-12 |
| 1265955983 | Deborah Ruth Stern Compton | Registered Nurse | 1291 Stanley Rd., Kennesaw, GA 30152 | 2017-07-25 |
| 1912452939 | Mak Anesthesia Holdings LLC | Anesthesiology | 1300 Ridenour Blvd., Ste. 300, Kennesaw, GA 30152 | 2016-08-19 |
| 1528430279 | Tineka Nichol Wyckoff | Counselor | 1967 Lake Heights Circle, Kennesaw, GA 30152 | 2015-10-21 |
| 1669753992 | American Current Care Pa | Clinic/Center | 2953 Cobb Parkway, Suite 400, Kennesaw, GA 30152 | 2011-08-31 |
| Find all providers in zip 30152 | ||||
| Taxonomy Code | 261QM2500X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Medical Specialty |
| An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer). |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154447043 | Spectrum Pediatric Grp | Clinic/Center | 3104 Creekside Village Dr, Suite 504, Kennesaw, GA 30144 | 2007-03-22 |
| 1831526276 | Nexslim of Cobb County, LLC | Clinic/Center | 1615 Ridenour Blvd Nw, Suite #202, Kennesaw, GA 30152-4463 | 2013-09-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598376865 | Deyoe Wellness | Clinic/Center | 47 Commerce Dr Ste 1b, Blairsville, GA 30512-8929 | 2020-08-11 |
| 1992331581 | World Spine and Orthopedics LLC | Clinic/Center | 4296 Memorial Dr Ste C, Decatur, GA 30032-1227 | 2020-03-16 |
| 1619517968 | Carroll Total Healthcare,pc | Clinic/Center | 410 Peachtree Pkwy Ste 4226, Cumming, GA 30041-7439 | 2020-01-14 |
| 1528601200 | Blued Consultant Solutions, LLC | Clinic/Center | 256 Rainbow Ln, Mcdonough, GA 30252-4839 | 2019-10-24 |
| 1578113585 | Centro Prenatal De Gwinnett LLC | Clinic/Center | 575 W Pike St Ste 1, Lawrenceville, GA 30046-7685 | 2019-09-12 |
| 1316508815 | Atlanta Health Clinic LLC | Clinic/Center | 2480 Windy Hill Rd Se Ste 404, Marietta, GA 30067-8658 | 2019-06-25 |
| 1659880847 | Jones Medical and Educational Consultants | Clinic/Center | 8954 Hospital Dr Bldg C, Douglasville, GA 30134-2200 | 2017-09-20 |
| 1477005593 | Hirenirali LLC | Clinic/Center | 12390 Beragio Pl, Alpharetta, GA 30004-4188 | 2016-10-25 |
| 1851840961 | Tele Doctor Direct Inc | Clinic/Center | 1250 Powers Ferry Cmn Se, Suite 100, Marietta, GA 30067-6046 | 2016-09-30 |
| 1154870533 | Life Point Medical, LLC | Clinic/Center | 189 Bo James Street, Suite 105, Clayton, GA 30525 | 2016-09-27 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on SHELTON SPORTS AND SPINE.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.