Provider Demographics
NPI:1740486976
Name:SHAH, DIMPLE D (MD)
Entity type:Individual
Prefix:
First Name:DIMPLE
Middle Name:D
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:137 JOHNSON FERRY RD
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-4945
Mailing Address - Country:US
Mailing Address - Phone:404-251-1912
Mailing Address - Fax:678-843-9650
Practice Address - Street 1:137 JOHNSON FERRY RD
Practice Address - Street 2:SUITE 1200
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-4945
Practice Address - Country:US
Practice Address - Phone:404-251-1912
Practice Address - Fax:678-843-9650
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA059329207R00000X
FLME105115207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CW207ZMedicare PIN
GA202I113423Medicare PIN