Healthcare Provider Details

I. General information

NPI: 1902147093
Provider Name (Legal Business Name): STUART K. SHAPIRA MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2013
Last Update Date: 03/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 CLIFTON RD., MAILSTOP E-87
ATLANTA GA
30333
US

IV. Provider business mailing address

1600 CLIFTON RD., MAILSTOP E-87
ATLANTA GA
30333
US

V. Phone/Fax

Practice location:
  • Phone: 404-498-3550
  • Fax: 404-498-3070
Mailing address:
  • Phone: 404-498-3550
  • Fax: 404-498-3070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number56645
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: