Provider Demographics
NPI:1114207727
Name:KIRITKUMAR J. SHAH, M.D.,PC
Entity Type:Organization
Organization Name:KIRITKUMAR J. SHAH, M.D.,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KIRITKUMAR
Authorized Official - Middle Name:JIVANLAL
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-948-8600
Mailing Address - Street 1:6360 MABLETON PKWY SW
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-5210
Mailing Address - Country:US
Mailing Address - Phone:770-948-8600
Mailing Address - Fax:770-944-7900
Practice Address - Street 1:6360 MABLETON PKWY SW
Practice Address - Street 2:
Practice Address - City:MABLETON
Practice Address - State:GA
Practice Address - Zip Code:30126-5210
Practice Address - Country:US
Practice Address - Phone:770-948-8600
Practice Address - Fax:770-944-7900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-26
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00246287AMedicaid