MEDICARE: SHAHINA MIRZA 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	2084P0800X	Psychiatry Physician	027297	GA
2	103TH0100X	Health Service Psychologist

General Provider Information

NPI Number	:	1891744090
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAHINA MIRZA MD

Provider Business Mailing Address
First Line	:	445 WINN WAY
Second Line	:	PO BOX 1648
City	:	DECATUR
State	:	GA
Zip	:	30030-1707
Country	:	US
Telephone Number	:	404-294-3835
Fax Number	:	404-508-7795

Provider Business Practice Location Address
First Line	:	445 WINN WAY
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30030-1707
Country	:	US
Telephone Number	:	404-294-3835
Fax Number	:	404-508-7795

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

Provider Enumeration Date	:	05/08/2006
Last Update Date	:	11/18/2015

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