Shelia Keresa Childers, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

003045 Issued in GA

Practice address

100 Gross Crescent Cir
Fort Oglethorpe, GA 30742-3643

Phone

(706) 858-2161

Fax

(865) 560-7387

NPI assigned

Jul 1, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151712000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1326240000000",
    "number": "1558390658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 634909",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452636019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 GROSS CRESCENT CIR",
            "city": "FORT OGLETHORPE",
            "state": "GA",
            "postal_code": "307423643",
            "telephone_number": "706-858-2161",
            "fax_number": "865-560-7387"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHILDERS",
        "first_name": "SHELIA",
        "middle_name": "KERESA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-01",
        "last_updated": "2012-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "003045",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00231570",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100002328D",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF TENNESSEE",
            "identifier": "P00231570",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Charles Dunlap, DDS
• Heather Cooper Chastain, DPT
• Chattanooga Women'S Specialists PC
• Kaushal Shambhubhai Chaudhari, M.D.
• CHI National Home Care, LLC
• Starlan James Childers
• Roger Fair Clem, CCC-A
• Anna M Cline, CNM
• James Ronald Cline, LCSW
• Althea Elizabeth Coffeen, PT

• Physician Assistant in Fort Oglethorpe, GA
• Providers in Fort Oglethorpe, GA by specialty
• Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.