Provider Demographics
NPI:1194491506
Name:GILES, SHELBY
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:GILES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:458 HEMLOCK ST STE 200
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-4200
Mailing Address - Country:US
Mailing Address - Phone:478-741-5945
Mailing Address - Fax:
Practice Address - Street 1:1282 S HOUSTON LAKE RD
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-2723
Practice Address - Country:US
Practice Address - Phone:478-313-3509
Practice Address - Fax:478-313-3517
Is Sole Proprietor?:No
Enumeration Date:2021-08-17
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN258729363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology