Healthcare Provider Details

I. General information

NPI: 1538718069
Provider Name (Legal Business Name): AL HAJ SHAH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2019
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6325 HOSPITAL PKWY
JOHNS CREEK GA
30097-5775
US

IV. Provider business mailing address

6325 HOSPITAL PKWY
JOHNS CREEK GA
30097-5775
US

V. Phone/Fax

Practice location:
  • Phone: 212-746-6490
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number248546
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP248546
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number776334
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number248546
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: