Provider Demographics
NPI:1700946258
Name:KARIM SHAKOOR, M.D.,P.C.
Entity Type:Organization
Organization Name:KARIM SHAKOOR, M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:P.C.
Authorized Official - Prefix:DR
Authorized Official - First Name:KARIM
Authorized Official - Middle Name:K
Authorized Official - Last Name:SHAKOOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-922-7000
Mailing Address - Street 1:1380 MILSTEAD AVE NE
Mailing Address - Street 2:SUITE-C
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30012-3864
Mailing Address - Country:US
Mailing Address - Phone:770-922-7000
Mailing Address - Fax:770-922-8070
Practice Address - Street 1:1380 MILSTEAD AVE NE
Practice Address - Street 2:SUITE-C
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-3864
Practice Address - Country:US
Practice Address - Phone:770-922-7000
Practice Address - Fax:770-922-8070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA43283207R00000X
GA43282207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00751352BMedicaid
GA00751352BMedicaid
GAGRP3843Medicare PIN