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General NPI Number Information
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NPI Number | 1720445083
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Entity Type | Organization
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Legal Business Name | SHIVANI HEALTHCARE OF GEORGIA LLC
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Dates
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Enumeration Date | 01/18/2016
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Last Update Date | 01/21/2016
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Provider Practice Location Address
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Address Line | 4090 PINESET DR
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City | ALPHARETTA
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State | GA
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Zip | 30022-4969
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Country | US
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Telephone | 908-489-0888
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Fax | 770-695-0400
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Provider Business Mailing Address
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Address Line | 4090 PINESET DR
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City | ALPHARETTA
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State | GA
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Zip | 30022-4969
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Country | US
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Telephone | 908-489-0888
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Fax | 770-695-0400
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Authorized Official
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Title or Position | ORGANIZER
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Name | PANCHSHIL M PATEL
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Credential | MD
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Telephone | 908-489-0888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 60229
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License Number State | GA
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