Provider Demographics
NPI:1457312704
Name:SHAH, NIKHIL LALIT (DO, MPH)
Entity Type:Individual
Prefix:DR
First Name:NIKHIL
Middle Name:LALIT
Last Name:SHAH
Suffix:
Gender:M
Credentials:DO, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:275 COLLIER RD NW
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1709
Mailing Address - Country:US
Mailing Address - Phone:404-605-4848
Mailing Address - Fax:404-351-5517
Practice Address - Street 1:275 COLLIER RD NW
Practice Address - Street 2:SUITE 400
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1709
Practice Address - Country:US
Practice Address - Phone:404-605-4848
Practice Address - Fax:404-351-5517
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101013642208800000X
GA057674208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA339403075BMedicaid
GA339403075BMedicaid