Provider Demographics
NPI:1699724419
Name:SHAH, DHAVAL SHRIKANT (MD)
Entity type:Individual
Prefix:
First Name:DHAVAL
Middle Name:SHRIKANT
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2320 ATLANTA HWY
Mailing Address - Street 2:STE 105
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-6339
Mailing Address - Country:US
Mailing Address - Phone:770-203-1000
Mailing Address - Fax:770-886-9908
Practice Address - Street 1:2320 ATLANTA HWY
Practice Address - Street 2:STE 105
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-6339
Practice Address - Country:US
Practice Address - Phone:770-203-1000
Practice Address - Fax:770-886-9908
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2014-08-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA52826207RS0012X, 207R00000X, 173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAI01329Medicare UPIN