Provider Demographics
NPI:1265774863
Name:SHAH, BHAVIK (MD)
Entity type:Individual
Prefix:DR
First Name:BHAVIK
Middle Name:
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:422 FAYETTEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-4805
Mailing Address - Country:US
Mailing Address - Phone:678-941-4140
Mailing Address - Fax:678-941-4139
Practice Address - Street 1:175 COUNTRY CLUB DR STE 300-E
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-9054
Practice Address - Country:US
Practice Address - Phone:678-941-4140
Practice Address - Fax:678-941-4139
Is Sole Proprietor?:No
Enumeration Date:2013-03-21
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA080996208800000X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology