Provider Demographics
NPI:1396937538
Name:SHENARA AUSTIN SEXTON, MD, LLC
Entity type:Organization
Organization Name:SHENARA AUSTIN SEXTON, MD, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHENARA
Authorized Official - Middle Name:AUSTIN
Authorized Official - Last Name:SEXTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-552-1226
Mailing Address - Street 1:1181 LANGFORD DR
Mailing Address - Street 2:BLDG. 300, SUITE 103
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677
Mailing Address - Country:US
Mailing Address - Phone:706-552-1226
Mailing Address - Fax:706-552-1227
Practice Address - Street 1:1181 LANGFORD DR
Practice Address - Street 2:BLDG. 300, SUITE 103
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677
Practice Address - Country:US
Practice Address - Phone:706-552-1226
Practice Address - Fax:706-552-1227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA053161207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty