Provider Demographics
NPI:1346220779
Name:JAITLY, SHALINI (MD)
Entity Type:Individual
Prefix:
First Name:SHALINI
Middle Name:
Last Name:JAITLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHALINI
Other - Middle Name:J
Other - Last Name:PANDEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1000 JOHNSON FERRY RD
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1606
Mailing Address - Country:US
Mailing Address - Phone:404-851-8000
Mailing Address - Fax:404-851-6325
Practice Address - Street 1:1000 JOHNSON FERRY RD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1606
Practice Address - Country:US
Practice Address - Phone:404-851-8000
Practice Address - Fax:404-851-6325
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA050727208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA10045143OtherAMERIGROUP
GA340878OtherWELLCARE
GAP00061909OtherRR MEDICARE-GRP # CC4177
GA000925999AMedicaid
GA3514521OtherCIGNA
GA52887002OtherBCBS
GA003155183AMedicaid
GA003155183BMedicaid
GA7600091OtherUNITED HEALTHCARE
GA202I119019Medicare PIN
GA52887002OtherBCBS