Healthcare Provider Details

I. General information

NPI: 1700946258
Provider Name (Legal Business Name): KARIM SHAKOOR, M.D.,P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 01/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 MILSTEAD AVE NE SUITE-C
CONYERS GA
30012-3864
US

IV. Provider business mailing address

1380 MILSTEAD AVE NE SUITE-C
CONYERS GA
30012-3864
US

V. Phone/Fax

Practice location:
  • Phone: 770-922-7000
  • Fax: 770-922-8070
Mailing address:
  • Phone: 770-922-7000
  • Fax: 770-922-8070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number43283
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number43282
License Number StateGA

VIII. Authorized Official

Name: DR. KARIM K SHAKOOR
Title or Position: P.C.
Credential: M.D.
Phone: 770-922-7000