Provider Demographics
NPI:1346489200
Name:KOTHARI, SHAILESH S (DC)
Entity Type:Individual
Prefix:DR
First Name:SHAILESH
Middle Name:S
Last Name:KOTHARI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1938 COBBLESTONE CIR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30319-4905
Mailing Address - Country:US
Mailing Address - Phone:770-938-2625
Mailing Address - Fax:404-477-0906
Practice Address - Street 1:800 VIRGINIA AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:HAPEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30354-4302
Practice Address - Country:US
Practice Address - Phone:770-938-2625
Practice Address - Fax:404-549-3393
Is Sole Proprietor?:No
Enumeration Date:2009-02-16
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO08446111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor