Provider Demographics
NPI:1285752196
Name:SHELTON SCOTT, CHARLESETTA (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLESETTA
Middle Name:
Last Name:SHELTON SCOTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CHARLESETTA
Other - Middle Name:
Other - Last Name:SHELTON-SCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:317 WOODWARD AVE SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-2123
Mailing Address - Country:US
Mailing Address - Phone:404-432-1531
Mailing Address - Fax:
Practice Address - Street 1:317 WOODWARD AVE SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-2123
Practice Address - Country:US
Practice Address - Phone:404-432-1531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.1200822084P0804X
GA0324722084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry