Provider Demographics
NPI:1407417363
Name:SHAH, TIRTH J (MD)
Entity type:Individual
Prefix:
First Name:TIRTH
Middle Name:J
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1620 PRINCE AVE
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-6008
Mailing Address - Country:US
Mailing Address - Phone:706-546-0170
Mailing Address - Fax:706-546-5015
Practice Address - Street 1:1620 PRINCE AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-6008
Practice Address - Country:US
Practice Address - Phone:706-546-0170
Practice Address - Fax:706-546-5015
Is Sole Proprietor?:No
Enumeration Date:2019-06-21
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR-11668207R00000X, 207W00000X
GA96206207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine