Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 037520 | GA |
N | 207Q00000X | Family Doctor | GA037520 | GA |
N | 207QA0505X | Family Doctor - Adult Medicine | 037520 | GA |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 037520 | GA |
N | 207U00000X | Nuclear Medicine Specialist | GA037520 | GA |
NPI | 1760512016 |
---|---|
Provider Name | Shashikant A Daya |
First Address | East Point, GA 30344-5012 |
Second Address | East Point, GA 30344-5012 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2007 |
Last Update Date | 19/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
360335904B | (05) | GA |
G84829 | (02) | GA |
GRP7052 | MEDICARE GROUP PIN (01) | GA |