Provider Demographics
NPI:1083111413
Name:SHEBELUT, CONRAD WILLIAM (MD)
Entity type:Individual
Prefix:DR
First Name:CONRAD
Middle Name:WILLIAM
Last Name:SHEBELUT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 CRESCENT WALK
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-2402
Mailing Address - Country:US
Mailing Address - Phone:559-269-0183
Mailing Address - Fax:
Practice Address - Street 1:2580 WESTSIDE PKWY
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-7426
Practice Address - Country:US
Practice Address - Phone:678-248-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-11
Last Update Date:2024-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA91228207ZH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology