Provider Demographics
NPI:1508865718
Name:CHOKKALINGAM, SHOBASHALINI (MD)
Entity Type:Individual
Prefix:DR
First Name:SHOBASHALINI
Middle Name:
Last Name:CHOKKALINGAM
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:PO BOX 925
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30903-0925
Mailing Address - Country:US
Mailing Address - Phone:706-854-6008
Mailing Address - Fax:706-774-7230
Practice Address - Street 1:2258 WRIGHTSBORO RD STE 400
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-4788
Practice Address - Country:US
Practice Address - Phone:706-724-4400
Practice Address - Fax:706-724-6003
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01060574A207RC0000X
OH35.093996207RC0000X
IL036134707207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP01369970OtherRAILROAD
IL036134707Medicaid
WI1508865718Medicaid
OH2969453Medicaid
IN200520590AMedicaid
IN200520590AMedicaid
OHH107810Medicare PIN
OH2969453Medicaid
ILP01369970OtherRAILROAD
INP00241368Medicare PIN
IN248520PPMedicare PIN