=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730341710
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SACHIN SHETH MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/30/2008
-----------------------------------------------------
Last Update Date | 04/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1035 SOUTHCREST DR STE AND250
-----------------------------------------------------
City | STOCKBRIDGE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30281-6118
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-915-2000
-----------------------------------------------------
Fax | 404-868-3363
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3225 CUMBERLAND BLVD SE STE 520
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30339-6407
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-915-2000
-----------------------------------------------------
Fax | 404-868-3363
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | LL30918
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2085R0204X
-----------------------------------------------------
Taxonomy Name | Vascular & Interventional Radiology Physician
-----------------------------------------------------
License Number | 75546
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------