Provider Demographics
NPI:1821109463
Name:SHAKOOR, NASEEM (MD)
Entity Type:Individual
Prefix:DR
First Name:NASEEM
Middle Name:
Last Name:SHAKOOR
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 1:1380 MILSTEAD AVE NE
Mailing Address - Street 2:SUITE-C
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30012-3864
Mailing Address - Country:US
Mailing Address - Phone:770-922-7000
Mailing Address - Fax:770-922-8070
Practice Address - Street 1:1380 MILSTEAD AVE NE
Practice Address - Street 2:SUITE-C
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-3864
Practice Address - Country:US
Practice Address - Phone:770-922-7000
Practice Address - Fax:770-922-8070
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA43283207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA849883539AMedicaid
GA849883539AMedicaid
GAG02412Medicare UPIN