Provider Demographics
NPI:1407823719
Name:SHELNUTT, JOHN JUDSON (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JUDSON
Last Name:SHELNUTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 OGLETHORPE AVE
Mailing Address - Street 2:SUITE 200B
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2179
Mailing Address - Country:US
Mailing Address - Phone:706-227-1164
Mailing Address - Fax:706-227-1971
Practice Address - Street 1:1500 OGLETHORPE AVE
Practice Address - Street 2:SUITE 200B
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2179
Practice Address - Country:US
Practice Address - Phone:706-227-1164
Practice Address - Fax:706-227-1971
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-06
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA046813207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000827197AMedicaid
GA000827197AMedicaid
GA16BDSVKMedicare ID - Type Unspecified