Provider Demographics
NPI:1922553023
Name:SHREE YAMUNA MAHARANIJI,PC
Entity Type:Organization
Organization Name:SHREE YAMUNA MAHARANIJI,PC
Other - Org Name:COBB MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHANDRESH
Authorized Official - Middle Name:B
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-941-0010
Mailing Address - Street 1:2615 E WEST CONNECTOR STE 106
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-6848
Mailing Address - Country:US
Mailing Address - Phone:770-941-0010
Mailing Address - Fax:770-941-0154
Practice Address - Street 1:2615 E WEST CONNECTOR STE 106
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-6848
Practice Address - Country:US
Practice Address - Phone:770-941-0010
Practice Address - Fax:770-941-0154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-18
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA038955261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center