Healthcare Provider Details

I. General information

NPI: 1760512016
Provider Name (Legal Business Name): SHASHIKANT A DAYA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 10/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3305 BOBBY BROWN PKWY
EAST POINT GA
30344-5012
US

IV. Provider business mailing address

3305 BOBBY BROWN PKWY
EAST POINT GA
30344-5012
US

V. Phone/Fax

Practice location:
  • Phone: 404-806-8181
  • Fax: 770-456-5469
Mailing address:
  • Phone: 404-806-8181
  • Fax: 770-456-5469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number037520
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number037520
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberGA037520
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number037520
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number037520
License Number StateGA
# 6
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number037520
License Number StateGA
# 7
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License NumberGA037520
License Number StateGA
# 8
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License NumberGA037520
License Number StateGA
# 9
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number037520
License Number StateGA
# 10
Primary TaxonomyN
Taxonomy Code207UN0902X
TaxonomyNuclear Imaging & Therapy Physician
License NumberGA037520
License Number StateGA
# 11
Primary TaxonomyN
Taxonomy Code207UN0902X
TaxonomyNuclear Imaging & Therapy Physician
License Number037520
License Number StateGA
# 12
Primary TaxonomyN
Taxonomy Code207UN0903X
TaxonomyIn Vivo & In Vitro Nuclear Medicine Physician
License NumberGA037520
License Number StateGA
# 13
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number037520
License Number StateGA
# 14
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number037520
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: