Provider Demographics
NPI:1619044724
Name:SHEALY, JAMES WELTON (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:WELTON
Last Name:SHEALY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:16 FELTON PL # B
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-2152
Mailing Address - Country:US
Mailing Address - Phone:770-382-3536
Mailing Address - Fax:770-382-1915
Practice Address - Street 1:16 FELTON PL # B
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-2152
Practice Address - Country:US
Practice Address - Phone:770-382-3536
Practice Address - Fax:770-382-1915
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN12013092A1223P0221X
OH30.0252911223P0221X
MI29010229571223P0221X
SC84981223P0221X
TN103801223P0221X
TX361211223P0221X
WI10017591223P0221X
GADN0113691223P0221X
PADS0425631223P0221X
IA094801223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA100517OtherAVESIS MEDICAID
GA9181146OtherDORAL MEDICAID
GA00746798BMedicaid