Healthcare Provider Details

I. General information

NPI: 1700677283
Provider Name (Legal Business Name): SHUBHANKAR JOSHI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2025
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 15TH ST BG 1071E
AUGUSTA GA
30912-0004
US

IV. Provider business mailing address

255 NORTH RD UNIT 17
CHELMSFORD MA
01824-1438
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-5036
  • Fax: 706-721-9463
Mailing address:
  • Phone: 978-876-7765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number17769
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: