Healthcare Provider Details

I. General information

NPI: 1306820253
Provider Name (Legal Business Name): SHABBIR MOTIWALA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 03/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 SAINT MARYS RD
COLUMBUS GA
31907-6258
US

IV. Provider business mailing address

4000 SAINT MARYS RD
COLUMBUS GA
31907-6258
US

V. Phone/Fax

Practice location:
  • Phone: 706-685-2770
  • Fax: 706-685-3299
Mailing address:
  • Phone: 706-660-8505
  • Fax: 706-660-9390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number36581
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: