Healthcare Provider Details

I. General information

NPI: 1013622901
Provider Name (Legal Business Name): HANNAH SHAH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2023
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 JOHNSON FERRY RD NE BLDG 2, STE 180
ATLANTA GA
30342-1709
US

IV. Provider business mailing address

1100 JOHNSON FERRY RD NE BLDG 2, STE 180
ATLANTA GA
30342-1709
US

V. Phone/Fax

Practice location:
  • Phone: 404-250-6691
  • Fax: 404-250-8847
Mailing address:
  • Phone: 404-250-6691
  • Fax: 404-250-8847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number13101
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: