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General NPI Number Information
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NPI Number | 1013192384
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Entity Type | Individual
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Provider Name | SAFAL SHETTY MD
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Gender | Male
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Dates
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Enumeration Date | 01/07/2008
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Last Update Date | 10/02/2019
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Provider Practice Location Address
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Address Line | 6001 PROFESSIONAL PKWY STE 2020
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City | DOUGLASVILLE
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State | GA
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Zip | 30134-5632
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Country | US
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Telephone | 770-422-1372
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Fax |
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Provider Business Mailing Address
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Address Line | 6001 PROFESSIONAL PKWY STE 2020
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City | DOUGLASVILLE
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State | GA
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Zip | 30134-5632
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Country | US
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Telephone | 770-422-1372
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RS0012X
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Taxonomy Name | Sleep Medicine (Internal Medicine) Physician
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License Number | 57280
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 207RS0012X
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Taxonomy Name | Sleep Medicine (Internal Medicine) Physician
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License Number | 83690
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 207RS0012X
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Taxonomy Name | Sleep Medicine (Internal Medicine) Physician
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License Number | 46703
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License Number State | AZ
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Taxonomy #4
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 83690
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License Number State | GA
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