MEDICARE: MANISH GIRISH SHAH M.D.

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	2085R0202X	Diagnostic Radiology Physician	099200	OH
2	2085R0202X	Diagnostic Radiology Physician	069708	GA

General Provider Information

NPI Number	:	1669675658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANISH GIRISH SHAH M.D.

Provider Business Mailing Address
First Line	:	1231 FOUNDERS LAKE DR
Second Line	:
City	:	ATHENS
State	:	GA
Zip	:	30606-7645
Country	:	US
Telephone Number	:	706-495-9897
Fax Number	:

Provider Business Practice Location Address
First Line	:	1231 FOUNDERS LAKE DR
Second Line	:
City	:	ATHENS
State	:	GA
Zip	:	30606-7645
Country	:	US
Telephone Number	:	706-495-9897
Fax Number	:

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

Provider Enumeration Date	:	06/07/2007
Last Update Date	:	12/27/2013

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Directions to “ MANISH GIRISH SHAH M.D.” Practice Location

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