Provider Demographics
NPI:1528399045
Name:NISON H. SHLEIFER MD PA
Entity Type:Organization
Organization Name:NISON H. SHLEIFER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NISON
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:SHLEIFER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-524-6038
Mailing Address - Street 1:340 BOULEVARD NE
Mailing Address - Street 2:SUITE 530
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-1273
Mailing Address - Country:US
Mailing Address - Phone:404-524-6038
Mailing Address - Fax:
Practice Address - Street 1:340 BOULEVARD NE
Practice Address - Street 2:SUITE 530
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-1273
Practice Address - Country:US
Practice Address - Phone:404-524-6038
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-22
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA17298207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00138036AMedicaid
D30813Medicare UPIN