Provider Demographics
NPI:1407090459
Name:SHAPIRO, EDAN (MD)
Entity Type:Individual
Prefix:
First Name:EDAN
Middle Name:
Last Name:SHAPIRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1930 BRANNAN RD
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-4310
Mailing Address - Country:US
Mailing Address - Phone:678-284-4040
Mailing Address - Fax:678-284-4076
Practice Address - Street 1:1336 HIGHWAY 54 W
Practice Address - Street 2:BLDG 200
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-4535
Practice Address - Country:US
Practice Address - Phone:770-460-9777
Practice Address - Fax:770-460-0650
Is Sole Proprietor?:No
Enumeration Date:2009-04-21
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA73486208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology