Jeffrrey Cornelius Shelley
Individual provider Active NPI Registered Nurse · Kingston, GA
NPI 1942950290 · NPPES record last updated Mar 28, 2022
Key facts
- NPI
- 1942950290
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- RN217906 (GA)
- Practice address
- 504 Gill Rd
Kingston, GA 30145-1334 - Phone
- (770) 769-8881
- NPI assigned
- Mar 28, 2022
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN217906 | GA | MD | Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | RN217906 | GA | Yes |
Addresses
Primary practice location
504 Gill Rd
Kingston, GA 30145-1334
Mailing address
504 Gill Rd
Kingston, GA 30145-1334
Phone (770) 769-8881
Other providers in Kingston, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 28, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.