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Individual

DR. PHESTON GRAY SHELTON IV

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
905 JOHNS HOPKINS DR, GREENVILLE, NC 27834-2056
(252) 744-1406
Mailing address
PO BOX 751069, CHARLOTTE, NC 28275-1069

Taxonomy

Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
2009-00479
NC
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
2009-00479
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
179PE
BCBSNC
NC
05
1811180607
NC
05
Q0047Y
SC
Enumeration date
08/24/2007
Last updated
02/03/2021
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