Healthcare Provider Details

I. General information

NPI: 1689864456
Provider Name (Legal Business Name): JESSE SHRIKI D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2007
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 COLLIER RD NW STE 5015
ATLANTA GA
30309-1721
US

IV. Provider business mailing address

15333 N PIMA RD STE 305
SCOTTSDALE AZ
85260-2717
US

V. Phone/Fax

Practice location:
  • Phone: 404-605-6517
  • Fax:
Mailing address:
  • Phone: 602-703-7813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number4707
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number100519
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: