Provider Demographics
NPI:1104810027
Name:SHAH, NIKHIL S (MD)
Entity type:Individual
Prefix:
First Name:NIKHIL
Middle Name:S
Last Name:SHAH
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2106 OOLTEWAH RINGGOLD RD
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-9345
Mailing Address - Country:US
Mailing Address - Phone:423-760-4360
Mailing Address - Fax:423-760-4367
Practice Address - Street 1:780 CANTON RD NE STE 328
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-7289
Practice Address - Country:US
Practice Address - Phone:943-610-0145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-07
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36425207RG0100X
GA100040207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3875889Medicaid
TN3875889Medicare PIN
TNF11943Medicare UPIN