Provider Demographics
NPI:1366476053
Name:SHAH, RANJAN C (MD)
Entity Type:Individual
Prefix:
First Name:RANJAN
Middle Name:C
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3643 SOUTHLAND DR
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-7095
Mailing Address - Country:US
Mailing Address - Phone:678-570-9750
Mailing Address - Fax:
Practice Address - Street 1:3643 SOUTHLAND DR
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519-7095
Practice Address - Country:US
Practice Address - Phone:678-570-9750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0297802084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
D41090Medicare UPIN
26BDKFKMedicare ID - Type Unspecified