Healthcare Provider Details

I. General information

NPI: 1952689200
Provider Name (Legal Business Name): SHWETA NAVNEET MAHESHWARI D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHWETA MAHESHWARI REDDY D.O.

II. Dates (important events)

Enumeration Date: 08/03/2011
Last Update Date: 07/21/2022
Certification Date: 04/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4905 COURTNEY DR
FOREST PARK GA
30297-1427
US

IV. Provider business mailing address

4905 COURTNEY DR
FOREST PARK GA
30297-1427
US

V. Phone/Fax

Practice location:
  • Phone: 404-366-3636
  • Fax: 404-362-0808
Mailing address:
  • Phone: 404-366-3636
  • Fax: 404-362-0808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number34.011361
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number078830
License Number StateGA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0104982
Identifier TypeMEDICAID
Identifier StateOH
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: