Individual
DR. SHELLEY MACHUTA FERNANDES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1100 NORTHSIDE FORSYTH DR, STE 140, CUMMING, GA 30041-6012
(770) 292-7000
(770) 292-7002
Mailing address
1100 NORTHSIDE FORSYTH DR, STE 140, CUMMING, GA 30041-6012
(770) 292-7000
(770) 292-7002
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
044272
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000929585B
—
GA
05
—
000929585D
—
GA
05
—
000929585V
—
GA
05
—
457240757A
—
GA
Enumeration date
12/01/2005
Last updated
02/02/2017
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