Individual provider Active NPI

Richard Russell Shelton Jr., MD

  • Pediatrics Physician
  • Buford, GA
National Provider Identifier
1619947769
Registry record updated Feb 4, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
043775 Issued in GA
Practice address
4095 S Lee St
Buford, GA 30518-3647
Phone
(770) 932-8519
Fax
(770) 533-4798
NPI assigned
Jan 23, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 043775 GA Primary

Addresses

Primary practice location

4095 S Lee St
Buford, GA 30518-3647

Mailing address

PO Box 1060
Oakwood, GA 30566-0018
Phone (770) 718-1122

Other practice location 1

1400 River Pl
Braselton, GA 30517-5600
Phone (770) 535-3611

Other practice location 2

725 Jesse Jewell Pkwy SE
Gainesville, GA 30501-3834
Phone (770) 535-3611

Other practice location 3

155 Professional Dr
Baldwin, GA 30511-4000
Phone (706) 776-2368

Other practice location 4

1270 Friendship Rd
Braselton, GA 30517-5630
Phone (678) 207-4200

Other practice location 5

4019 Executive Drive
Oakwood, GA 30566-3433
Phone (770) 533-6500

Other practice location 6

743 Spring St NE
Gainesville, GA 30501-3715
Phone (770) 535-3611

Other identifiers 15

IdentifierTypeStateIssuer
302587OtherGAWELLCARE
52684584OtherGABCBS
5402578OtherGAAETNA PPO
8238671OtherGACIGNA
000754157MMedicaidGA
000754157PMedicaidGA
000754157QMedicaidGA
1939869OtherGAUNITED HEALTHCARE
302571OtherGAWELLCARE
000754157NMedicaidGA
000754157RMedicaidGA
10032982OtherGAAMERIGROUP
302567OtherGAWELLCARE
2276934OtherGAAETNA HMO
302588OtherGAWELLCARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100803000744 GA Practitioner - Pediatric Medicine 7214060805 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Northeast Georgia Community Physicians LLC CurrentSince Feb 1, 2026 Accepting new patients
The Longstreet Clinic, PC Pediatrics CurrentSince Feb 12, 2010 Accepting new patients

Locations

155 Professional Dr
Baldwin, GA 30511
Phone (706) 776-2368

1270 Friendship Rd
Braselton, GA 30517
Phone (678) 207-4200

1400 River Pl
Braselton, GA 30517
Phone (770) 219-6000

4095 S Lee St
Buford, GA 30518
Phone (770) 932-8519

725 Jesse Jewell Pkwy SE
Gainesville, GA 30501
Phone (770) 297-2200

743 Spring St NE
Gainesville, GA 30501
Phone (770) 219-5915

4019 Executive Dr
Oakwood, GA 30566
Phone (770) 533-6500

Interoperability endpoints

  • Direct secure messaging: rick.shelton@longstreetclinic.gadirect.net

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1137974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1770163200000",
    "number": "1619947769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1060",
            "city": "OAKWOOD",
            "state": "GA",
            "postal_code": "305660018",
            "telephone_number": "770-718-1122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4095 S LEE ST",
            "city": "BUFORD",
            "state": "GA",
            "postal_code": "305183647",
            "telephone_number": "770-932-8519",
            "fax_number": "770-533-4798"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1400 River Pl",
            "address_purpose": "LOCATION",
            "city": "Braselton",
            "state": "GA",
            "postal_code": "305175600",
            "country_code": "US",
            "telephone_number": "770-535-3611",
            "fax_number": "770-535-7092",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "725 Jesse Jewell Pkwy SE",
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            "city": "Gainesville",
            "state": "GA",
            "postal_code": "305013834",
            "country_code": "US",
            "telephone_number": "770-535-3611",
            "fax_number": "770-535-7092",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "155 Professional Dr",
            "address_purpose": "LOCATION",
            "city": "Baldwin",
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            "postal_code": "305114000",
            "country_code": "US",
            "telephone_number": "706-776-2368",
            "fax_number": "706-776-2589",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1270 Friendship Rd",
            "address_purpose": "LOCATION",
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            "state": "GA",
            "postal_code": "305175630",
            "country_code": "US",
            "telephone_number": "678-207-4200",
            "fax_number": "770-533-4771",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4019 Executive Drive",
            "address_purpose": "LOCATION",
            "city": "Oakwood",
            "state": "GA",
            "postal_code": "305663433",
            "country_code": "US",
            "telephone_number": "770-533-6500",
            "fax_number": "770-533-6543",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "743 Spring St NE",
            "address_purpose": "LOCATION",
            "city": "Gainesville",
            "state": "GA",
            "postal_code": "305013715",
            "country_code": "US",
            "telephone_number": "770-535-3611",
            "fax_number": "770-535-7092",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHELTON",
        "first_name": "RICHARD",
        "middle_name": "RUSSELL",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-23",
        "last_updated": "2026-02-04",
        "certification_date": "2026-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "043775",
            "primary": true
        }
    ],
    "identifiers": [
        {
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            "desc": "Other (non-Medicare)",
            "issuer": "WELLCARE",
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        },
        {
            "code": "01",
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            "issuer": "BCBS",
            "identifier": "52684584",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PPO",
            "identifier": "5402578",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "8238671",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000754157M",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000754157P",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000754157Q",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "1939869",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLCARE",
            "identifier": "302571",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000754157N",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000754157R",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIGROUP",
            "identifier": "10032982",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLCARE",
            "identifier": "302567",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA HMO",
            "identifier": "2276934",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLCARE",
            "identifier": "302588",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Buford, GA

Sources for this page

Verify at the official NPI Registry.