Provider Demographics
NPI:1609880160
Name:BHATIA, SHAINUL K (MD)
Entity Type:Individual
Prefix:
First Name:SHAINUL
Middle Name:K
Last Name:BHATIA
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 1:1045 SYCAMORE DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-1645
Mailing Address - Country:US
Mailing Address - Phone:404-501-4270
Mailing Address - Fax:404-501-5797
Practice Address - Street 1:1045 SYCAMORE DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-1645
Practice Address - Country:US
Practice Address - Phone:404-501-4270
Practice Address - Fax:404-501-5797
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA027158207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D44861Medicare UPIN