Organization
SHELLBACK ENTERPRISE CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES ADAIR WELCH (COO)
(678) 873-2972
Entity
Organization
Contact information
Practice address
170 CAMDEN HILL RD, LAWRENCEVILLE, GA 30046-7418
(770) 338-6799
(770) 338-6799
Mailing address
PO BOX 2034, LAWRENCEVILLE, GA 30046-2034
(770) 338-6799
(678) 442-6440
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
—
Other
Enumeration date
02/23/2021
Last updated
02/23/2021
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