Provider Demographics
NPI:1629636683
Name:SHAH, MANAN (MD)
Entity Type:Individual
Prefix:MR
First Name:MANAN
Middle Name:
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 WESTVIEW DR, SW MOREHOUSE SCHOOL OF MEDICINE/GME,
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30310
Mailing Address - Country:US
Mailing Address - Phone:404-752-1857
Mailing Address - Fax:404-752-1088
Practice Address - Street 1:720 WESTVIEW DR, SW MOREHOUSE SCHOOL OF MEDICINE/GME,
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30310
Practice Address - Country:US
Practice Address - Phone:404-752-1857
Practice Address - Fax:404-752-1088
Is Sole Proprietor?:No
Enumeration Date:2019-06-04
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program