Healthcare Provider Details

I. General information

NPI: 1346220779
Provider Name (Legal Business Name): SHALINI JAITLY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHALINI J PANDEY MD

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 07/22/2022
Certification Date: 07/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 JOHNSON FERRY RD
ATLANTA GA
30342-1606
US

IV. Provider business mailing address

1000 JOHNSON FERRY RD
ATLANTA GA
30342-1606
US

V. Phone/Fax

Practice location:
  • Phone: 404-851-8000
  • Fax: 404-851-6325
Mailing address:
  • Phone: 404-851-8000
  • Fax: 404-851-6325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number050727
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: