MEDICARE: THE SHAFIQ GROUP

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	261QC1500X	Community Health Clinic/Center

General Provider Information

NPI Number	:	1700357878
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE SHAFIQ GROUP

Provider Business Mailing Address
First Line	:	910 ATHENS HWY STE K245
Second Line	:
City	:	LOGANVILLE
State	:	GA
Zip	:	30052-4952
Country	:	US
Telephone Number	:	770-445-4088
Fax Number	:

Provider Business Practice Location Address
First Line	:	910 ATHENS HWY STE K245
Second Line	:
City	:	LOGANVILLE
State	:	GA
Zip	:	30052-4952
Country	:	US
Telephone Number	:	770-445-4088
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KHALIL SHAFIQ
Credential	:
Telephone Number	:	770-455-4088

Provider Enumeration Date	:	12/16/2018
Last Update Date	:	12/16/2018

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Directions to “THE SHAFIQ GROUP ” Practice Location

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