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General NPI Number Information
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NPI Number | 1295806495
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Entity Type | Individual
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Provider Name | SHAHID RAFIQUE M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/11/2006
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Last Update Date | 10/09/2017
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Provider Practice Location Address
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Address Line | 2356 LENORA CHURCH RD
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City | SNELLVILLE
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State | GA
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Zip | 30078-3233
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Country | US
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Telephone | 770-972-0340
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Fax | 770-558-4140
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Provider Business Mailing Address
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Address Line | 2356 LENORA CHURCH RD
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City | SNELLVILLE
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State | GA
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Zip | 30078-3233
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Country | US
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Telephone | 770-972-0340
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Fax | 770-558-4140
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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 | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | 043268
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 043268
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License Number State | GA
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