Healthcare Provider Details

I. General information

NPI: 1497040265
Provider Name (Legal Business Name): SHREYAS GIRISH MAKWANA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2011
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11681 HAYNES BRIDGE RD STE 200
ALPHARETTA GA
30009-2713
US

IV. Provider business mailing address

11681 HAYNES BRIDGE RD STE 200
ALPHARETTA GA
30009-2713
US

V. Phone/Fax

Practice location:
  • Phone: 770-475-3146
  • Fax: 678-215-0688
Mailing address:
  • Phone: 770-475-3146
  • Fax: 678-215-0688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMD-36195
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number87258
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA134283
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMDR-6090
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: