Provider Demographics
NPI:1023451408
Name:SHIH, EDMOND (MD)
Entity type:Individual
Prefix:DR
First Name:EDMOND
Middle Name:
Last Name:SHIH
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 1:5461 BUFORD HWY NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30340-1124
Mailing Address - Country:US
Mailing Address - Phone:770-457-5556
Mailing Address - Fax:770-457-7776
Practice Address - Street 1:5461 BUFORD HWY NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30340-1124
Practice Address - Country:US
Practice Address - Phone:770-457-5556
Practice Address - Fax:770-457-7776
Is Sole Proprietor?:No
Enumeration Date:2013-04-16
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA076180207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003179826AMedicaid