Healthcare Provider Details

I. General information

NPI: 1790028769
Provider Name (Legal Business Name): AMIT DEEPAK SHAH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2013
Last Update Date: 04/12/2023
Certification Date: 04/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6458 MERIDIAN WAY
SANDY SPRINGS GA
30328-2895
US

IV. Provider business mailing address

6458 MERIDIAN WAY
SANDY SPRINGS GA
30328-2895
US

V. Phone/Fax

Practice location:
  • Phone: 678-524-7388
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number61098
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number04-41999
License Number StateKS
# 4
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number37207
License Number StateOK
# 5
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2019015696
License Number StateMO
# 6
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberE-12152
License Number StateAR
# 7
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberTM00838
License Number StateTX
# 8
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number80242
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: