Provider Demographics
NPI:1437271426
Name:SHAH, HIREN P (MD)
Entity Type:Individual
Prefix:
First Name:HIREN
Middle Name:P
Last Name:SHAH
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 1:2300 MANCHESTER EXPY STE 1003
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-6877
Mailing Address - Country:US
Mailing Address - Phone:706-243-2333
Mailing Address - Fax:706-324-5695
Practice Address - Street 1:2300 MANCHESTER EXPY STE 1003
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-6877
Practice Address - Country:US
Practice Address - Phone:706-243-2333
Practice Address - Fax:706-324-5695
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ36927207RC0000X
GA062433207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA112286780Medicaid
AL168482Medicaid
GA202I068789Medicare PIN