Provider Demographics
NPI:1316284359
Name:SHAH, AMITA ATUL
Entity type:Individual
Prefix:MRS
First Name:AMITA
Middle Name:ATUL
Last Name:SHAH
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 1:205 WATERFORD WAY
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-3247
Mailing Address - Country:US
Mailing Address - Phone:706-613-6473
Mailing Address - Fax:
Practice Address - Street 1:1860 BARNETT SHOALS RD
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30605-6811
Practice Address - Country:US
Practice Address - Phone:706-227-6265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-10
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA16274183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist