Provider Demographics
NPI:1407872948
Name:MEGHANI, SHAKIR (MD)
Entity Type:Individual
Prefix:
First Name:SHAKIR
Middle Name:
Last Name:MEGHANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2812 HARTFORD HWY
Mailing Address - Street 2:STE 1
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-4927
Mailing Address - Country:US
Mailing Address - Phone:334-712-1170
Mailing Address - Fax:334-460-8391
Practice Address - Street 1:2812 HARTFORD HWY STE 1
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-4927
Practice Address - Country:US
Practice Address - Phone:334-712-1170
Practice Address - Fax:334-460-8391
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL229172084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL194886Medicaid
AL134226Medicaid
AL051000548OtherOSC- BCBS
AL051534161OtherTROY - BCBS
AL051000550OtherSPS - BCBS
AL009979845Medicaid
AL0009937571Medicaid
AL009979035Medicaid