MEDICARE: SAFAL SHETTY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RS0012X	Sleep Medicine (Internal Medicine) Physician	57280	CT
2	207RS0012X	Sleep Medicine (Internal Medicine) Physician	83690	GA
3	207RS0012X	Sleep Medicine (Internal Medicine) Physician	46703	AZ
4	207RP1001X	Pulmonary Disease Physician	83690	GA

General Provider Information

NPI Number	:	1013192384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAFAL SHETTY MD

Provider Business Mailing Address
First Line	:	6001 PROFESSIONAL PKWY STE 2020
Second Line	:
City	:	DOUGLASVILLE
State	:	GA
Zip	:	30134-5632
Country	:	US
Telephone Number	:	770-422-1372
Fax Number	:

Provider Business Practice Location Address
First Line	:	6001 PROFESSIONAL PKWY STE 2020
Second Line	:
City	:	DOUGLASVILLE
State	:	GA
Zip	:	30134-5632
Country	:	US
Telephone Number	:	770-422-1372
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/07/2008
Last Update Date	:	10/02/2019

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Directions to “ SAFAL SHETTY MD” Practice Location

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