Provider Demographics
NPI:1457548513
Name:SHAH, MANAN B (MD)
Entity Type:Individual
Prefix:
First Name:MANAN
Middle Name:B
Last Name:SHAH
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 1:95 COLLIER RD NW
Mailing Address - Street 2:SUITE 475
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1796
Mailing Address - Country:US
Mailing Address - Phone:404-355-3200
Mailing Address - Fax:404-355-9819
Practice Address - Street 1:95 COLLIER RD NW
Practice Address - Street 2:SUITE 4085
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1796
Practice Address - Country:US
Practice Address - Phone:404-355-3200
Practice Address - Fax:404-355-9819
Is Sole Proprietor?:No
Enumeration Date:2007-10-02
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY247546207RG0100X
GA065613207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology