MEDICARE: DR. TALLAPRAGADA SHANKAR 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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	029242	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619980810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TALLAPRAGADA SHANKAR MD

Provider Business Mailing Address
First Line	:	1365 ROCK QUARRY RD
Second Line	:	SUITE 201
City	:	STOCKBRIDGE
State	:	GA
Zip	:	30281-5044
Country	:	US
Telephone Number	:	678-289-5054
Fax Number	:	678-565-0473

Provider Business Practice Location Address
First Line	:	1365 ROCK QUARRY RD
Second Line	:	SUITE 201
City	:	STOCKBRIDGE
State	:	GA
Zip	:	30281-5044
Country	:	US
Telephone Number	:	678-289-5054
Fax Number	:	678-565-0473

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

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	10/03/2007

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