Provider Demographics
NPI:1265656789
Name:INAYAT, SHAH (MD)
Entity Type:Individual
Prefix:
First Name:SHAH
Middle Name:
Last Name:INAYAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5114 J WHITE ROAD
Mailing Address - Street 2:
Mailing Address - City:OAKWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30566-3127
Mailing Address - Country:US
Mailing Address - Phone:770-297-8570
Mailing Address - Fax:770-246-1003
Practice Address - Street 1:5720 BUFORD HIGHWAY
Practice Address - Street 2:SUITE 106
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071
Practice Address - Country:US
Practice Address - Phone:770-246-1002
Practice Address - Fax:770-246-1003
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA047908207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00886971AMedicaid
GA00886971AMedicaid