Provider Demographics
NPI:1659559789
Name:SHOKAT, MAXIMILIAN SHAHRYAR (DO)
Entity Type:Individual
Prefix:DR
First Name:MAXIMILIAN
Middle Name:SHAHRYAR
Last Name:SHOKAT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 S HANSELL ST
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-5556
Mailing Address - Country:US
Mailing Address - Phone:229-226-2234
Mailing Address - Fax:229-226-2237
Practice Address - Street 1:615 S HANSELL ST
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-5556
Practice Address - Country:US
Practice Address - Phone:229-226-2234
Practice Address - Fax:229-226-2237
Is Sole Proprietor?:No
Enumeration Date:2008-01-31
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10271208VP0014X
GA60192208VP0014X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002427200Medicaid
GA511G700201Medicare PIN
FL002427200Medicaid
FLDF583ZMedicare PIN