Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | POD000637 | GA |
Y | 222Z00000X | Podiatrist | POD000637 | GA |
NPI | 1003918152 |
---|---|
Provider Name | Naim G. Shaheed |
First Address | Lithonia, GA 30058 |
Second Address | Lithonia, GA 30058 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2006 |
Last Update Date | 07/07/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
48SCBND | MEDICARE PROVIDER NUMBER (01) | GA |
ODD536313B | (05) | GA |
U18991 | (02) |