Provider Demographics
NPI:1447563572
Name:POPAT, SHITAL C (MD)
Entity Type:Individual
Prefix:
First Name:SHITAL
Middle Name:C
Last Name:POPAT
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 1:4800 OLDE TOWNE PKWY STE 400
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-4424
Mailing Address - Country:US
Mailing Address - Phone:678-718-2940
Mailing Address - Fax:678-718-2941
Practice Address - Street 1:4800 OLDE TOWNE PKWY STE 400
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-4424
Practice Address - Country:US
Practice Address - Phone:678-718-2940
Practice Address - Fax:678-718-2941
Is Sole Proprietor?:No
Enumeration Date:2010-07-19
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA78524207R00000X
TXQ1886207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003201008AMedicaid