Provider Demographics
NPI:1770685547
Name:SHEIKH, MUJTABA S (MD)
Entity Type:Individual
Prefix:
First Name:MUJTABA
Middle Name:S
Last Name:SHEIKH
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:PO BOX 658
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30503-0658
Mailing Address - Country:US
Mailing Address - Phone:770-718-1122
Mailing Address - Fax:770-535-7445
Practice Address - Street 1:1270 FRIENDSHIP RD
Practice Address - Street 2:
Practice Address - City:BRASELTON
Practice Address - State:GA
Practice Address - Zip Code:30517-5630
Practice Address - Country:US
Practice Address - Phone:678-207-4200
Practice Address - Fax:770-533-4771
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA055702208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA2928517070CMedicaid
GA424208OtherWELLCARE
GA01191774OtherAMERIGROUP
GA2928517070BMedicaid
GA582117020024OtherTRICARE
GA424145OtherWELLCARE
GA582117020030OtherTRICARE
GA2928517070DMedicaid
GA52703777OtherBCBS
GA530652OtherWELLCARE
GA582117020OtherTRICARE
GA2928517070FMedicaid
GA454241OtherWELLCARE
GA4858323OtherCIGNA
GA582117020018OtherTRICARE
GA7955625OtherAETNA
GA2928517070EMedicaid
GA454249OtherWELLCARE
GA2928517070EMedicaid
GA202I370660Medicare PIN