Provider Demographics
NPI:1962618579
Name:BETHEA, SHELDON (DC)
Entity type:Individual
Prefix:DR
First Name:SHELDON
Middle Name:
Last Name:BETHEA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2140 MCGEE RD
Mailing Address - Street 2:SUITE C145
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-2980
Mailing Address - Country:US
Mailing Address - Phone:678-514-2297
Mailing Address - Fax:678-638-1081
Practice Address - Street 1:2140 MCGEE RD
Practice Address - Street 2:SUITE C145
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-2980
Practice Address - Country:US
Practice Address - Phone:678-514-2297
Practice Address - Fax:678-638-1081
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR006133111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor