Provider Demographics
NPI:1366686594
Name:SHAH, SAMAR (MD)
Entity Type:Individual
Prefix:
First Name:SAMAR
Middle Name:
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1400 TULLIE RD NE FL 5
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-2309
Mailing Address - Country:US
Mailing Address - Phone:404-785-5437
Mailing Address - Fax:404-785-9087
Practice Address - Street 1:1400 TULLIE RD NE FL 5
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-2309
Practice Address - Country:US
Practice Address - Phone:404-785-5437
Practice Address - Fax:404-785-9087
Is Sole Proprietor?:No
Enumeration Date:2009-05-01
Last Update Date:2022-06-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA75245208000000X
GA00752452080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics