Provider Demographics
NPI:1447466784
Name:CHILTON SHELBY SUGERY, LLC
Entity type:Organization
Organization Name:CHILTON SHELBY SUGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:RAGHAVACHARI
Authorized Official - Middle Name:SUNDER
Authorized Official - Last Name:KRISHNAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-280-7700
Mailing Address - Street 1:PO BOX 1604
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35124-5604
Mailing Address - Country:US
Mailing Address - Phone:205-280-7700
Mailing Address - Fax:205-280-7088
Practice Address - Street 1:150 HEALTH CENTER DR
Practice Address - Street 2:
Practice Address - City:CLANTON
Practice Address - State:AL
Practice Address - Zip Code:35045-2368
Practice Address - Country:US
Practice Address - Phone:205-280-7700
Practice Address - Fax:205-280-7088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00018919208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALG17545Medicare UPIN