Provider Demographics
NPI:1821250267
Name:HARKINS, SHANIL LARA (MD)
Entity Type:Individual
Prefix:
First Name:SHANIL
Middle Name:LARA
Last Name:HARKINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHANIL
Other - Middle Name:
Other - Last Name:LARA RIVERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:711 CANTON RD NE STE 300
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-8949
Mailing Address - Country:US
Mailing Address - Phone:678-741-5000
Mailing Address - Fax:678-819-4280
Practice Address - Street 1:3747 ROSWELL RD STE 314
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062
Practice Address - Country:US
Practice Address - Phone:678-741-5000
Practice Address - Fax:770-321-1318
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA071807207RG0100X, 207RG0100X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003146414AMedicaid
GA202I107045Medicare UPIN