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General NPI Number Information
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NPI Number | 1346489200
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Entity Type | Individual
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Provider Name | SHAILESH S KOTHARI D.C.
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Gender | Male
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Dates
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Enumeration Date | 02/16/2009
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Last Update Date | 08/01/2011
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Provider Practice Location Address
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Address Line | 800 VIRGINIA AVE SUITE 200
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City | HAPEVILLE
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State | GA
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Zip | 30354-4302
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Country | US
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Telephone | 770-938-2625
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Fax | 404-549-3393
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Provider Business Mailing Address
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Address Line | 1938 COBBLESTONE CIR NE
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City | ATLANTA
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State | GA
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Zip | 30319-4905
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Country | US
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Telephone | 770-938-2625
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Fax | 404-477-0906
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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 | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CHIRO08446
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License Number State | GA
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