Provider Demographics
NPI:1609804434
Name:SHETTY, NARAYAN SESU (MD FAAP)
Entity Type:Individual
Prefix:MR
First Name:NARAYAN
Middle Name:SESU
Last Name:SHETTY
Suffix:
Gender:M
Credentials:MD FAAP
Other - Prefix:MR
Other - First Name:N
Other - Middle Name:S
Other - Last Name:SHETTY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:716 HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:GA
Mailing Address - Zip Code:30529
Mailing Address - Country:US
Mailing Address - Phone:706-335-2108
Mailing Address - Fax:706-335-0689
Practice Address - Street 1:716 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:GA
Practice Address - Zip Code:30529
Practice Address - Country:US
Practice Address - Phone:706-335-2108
Practice Address - Fax:706-335-0689
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA20816208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00181794AMedicaid