Provider Demographics
NPI:1740350669
Name:VALIANI, SHIRIN (MD)
Entity type:Individual
Prefix:
First Name:SHIRIN
Middle Name:
Last Name:VALIANI
Suffix:
Gender:F
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:PO BOX 1107
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:GA
Mailing Address - Zip Code:30228-0905
Mailing Address - Country:US
Mailing Address - Phone:770-946-4521
Mailing Address - Fax:770-946-5143
Practice Address - Street 1:25 GOSS DRIVE
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:GA
Practice Address - Zip Code:30228-1855
Practice Address - Country:US
Practice Address - Phone:770-946-4521
Practice Address - Fax:770-946-5143
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA038996207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA08BBQPBMedicare PIN
GAF95355Medicare UPIN