Provider Demographics
NPI:1720002983
Name:SHETH, JIGISH G (DO)
Entity Type:Individual
Prefix:
First Name:JIGISH
Middle Name:G
Last Name:SHETH
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 1:1015 MANSELL RD
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-1507
Mailing Address - Country:US
Mailing Address - Phone:770-521-2229
Mailing Address - Fax:770-521-2231
Practice Address - Street 1:1015 MANSELL RD
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-1507
Practice Address - Country:US
Practice Address - Phone:770-521-2229
Practice Address - Fax:770-521-2231
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036116515207V00000X
IN02003263207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200885420Medicaid