Provider Demographics
NPI:1508031873
Name:BANSAL, SHALABH SHEEL (MD, MBA)
Entity Type:Individual
Prefix:DR
First Name:SHALABH
Middle Name:SHEEL
Last Name:BANSAL
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Gender:M
Credentials:MD, MBA
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Mailing Address - Street 1:5665 NEW NORTHSIDE DR NW
Mailing Address - Street 2:SUITE 320
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-5831
Mailing Address - Country:US
Mailing Address - Phone:770-874-5400
Mailing Address - Fax:770-874-5433
Practice Address - Street 1:5665 NEW NORTHSIDE DR NW
Practice Address - Street 2:SUITE 320
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-5831
Practice Address - Country:US
Practice Address - Phone:770-874-5400
Practice Address - Fax:770-874-5433
Is Sole Proprietor?:No
Enumeration Date:2008-04-28
Last Update Date:2012-09-13
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Provider Licenses
StateLicense IDTaxonomies
IAR-8273208000000X
GA65993208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003120349BMedicaid
GA003120349CMedicaid