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Individual
MR. ROBERT J SHELLEY
Active
Individual
MR. ROBERT J SHELLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
028650
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000331361A
—
GA
01
—
028650
STATE LICENSE
GA
01
—
58-1102392
TAX ID#
GA
01
—
G28650
SC MEDICAID
SC
Enumeration date
09/08/2005
Last updated
03/07/2023
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