Provider Demographics
NPI:1720445083
Name:SHIVANI HEALTHCARE OF GEORGIA LLC
Entity Type:Organization
Organization Name:SHIVANI HEALTHCARE OF GEORGIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZER
Authorized Official - Prefix:
Authorized Official - First Name:PANCHSHIL
Authorized Official - Middle Name:M
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-489-0888
Mailing Address - Street 1:4090 PINESET DR
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-4969
Mailing Address - Country:US
Mailing Address - Phone:908-489-0888
Mailing Address - Fax:770-695-0400
Practice Address - Street 1:4090 PINESET DR
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-4969
Practice Address - Country:US
Practice Address - Phone:908-489-0888
Practice Address - Fax:770-695-0400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-18
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA60229207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty