Provider Demographics
NPI:1306820253
Name:MOTIWALA, SHABBIR (MD)
Entity Type:Individual
Prefix:
First Name:SHABBIR
Middle Name:
Last Name:MOTIWALA
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 1:4000 SAINT MARYS RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31907-6258
Mailing Address - Country:US
Mailing Address - Phone:706-660-8505
Mailing Address - Fax:706-660-9390
Practice Address - Street 1:4000 SAINT MARYS RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31907-6258
Practice Address - Country:US
Practice Address - Phone:706-685-2770
Practice Address - Fax:706-685-3299
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA36581207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00166219OtherRAILROAD MEDICARE
GA93BBHXDMedicare PIN
P00166219OtherRAILROAD MEDICARE
GAE52927Medicare UPIN
F52927Medicare UPIN
GA08BBWSBMedicare ID - Type Unspecified