Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 57839 | GA |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | 57839 | GA |
NPI | 1225062128 |
---|---|
Provider Name | Amit D Shah |
First Address | Athens, GA 30604-8089 |
Second Address | Athens, GA 30606-6192 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 28/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I60570 | (02) | GA |