Active NPI
Shelby Alexis Davis, LPC
- Specialist
- Marietta, GA
National Provider Identifier
1427266154
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- LPC004341
- Practice address
- 1640 Powers Ferry Rd
Building 2, Suite 150
Marietta, GA 30067-5491 - Phone
- (954) 401-4357
- NPI assigned
- May 18, 2007
- Last updated
- Jul 21, 2010
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | LPC004341 | GA | Primary |
Addresses
Primary practice location
1640 Powers Ferry Rd
Building 2, Suite 150
Marietta, GA 30067-5491
Mailing address
4790 Jett Rd NW
Atlanta, GA 30327-4566
Phone (954) 401-4357
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Feb 21, 2024 through Feb 21, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPC004341 | GA | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179446400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1279670400000",
"number": "1427266154",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4790 JETT RD NW",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303274566",
"telephone_number": "954-401-4357"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1640 POWERS FERRY RD",
"address_2": "BUILDING 2, SUITE 150",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300675491",
"telephone_number": "954-401-4357"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "SHELBY",
"middle_name": "ALEXIS",
"name_prefix": "Mrs.",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-18",
"last_updated": "2010-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "GA",
"license": "LPC004341",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Marietta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.