Provider Demographics
NPI:1629062468
Name:SHELLEY, ROBERT J (MD)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:J
Last Name:SHELLEY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4600 WATERS AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-6702
Mailing Address - Country:US
Mailing Address - Phone:912-355-2462
Mailing Address - Fax:912-353-1836
Practice Address - Street 1:4600 WATERS AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-6702
Practice Address - Country:US
Practice Address - Phone:912-355-2462
Practice Address - Fax:912-353-1836
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA028650208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA028650OtherSTATE LICENSE
GA000331361AMedicaid
SCG28650OtherSC MEDICAID
GA58-1102392OtherTAX ID#
GA58-1102392OtherTAX ID#
SCG28650OtherSC MEDICAID