Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | A108630 | CA |
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 67525 | GA |
NPI | 1275857542 |
---|---|
Provider Name | Shivan H Amin |
First Address | Atlanta, GA 30306-3526 |
Second Address | Decatur, GA 30033-6131 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2010 |
Last Update Date | 16/02/2021 |