Provider Demographics
NPI:1326122367
Name:SHAH, MAHENDRA RATILAL (MD)
Entity Type:Individual
Prefix:
First Name:MAHENDRA
Middle Name:RATILAL
Last Name:SHAH
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 1:227 SCENIC HWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045
Mailing Address - Country:US
Mailing Address - Phone:770-513-7666
Mailing Address - Fax:770-513-1093
Practice Address - Street 1:227 SCENIC HWY
Practice Address - Street 2:SUITE A
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045
Practice Address - Country:US
Practice Address - Phone:770-513-7666
Practice Address - Fax:770-513-1093
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0344662084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00525962DMedicaid
F13620Medicare UPIN
GA26BDHDBMedicare ID - Type Unspecified