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General NPI Number Information
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NPI Number | 1821208026
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Entity Type | Individual
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Provider Name | JENNIFER SHU M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 06/21/2012
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Provider Practice Location Address
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Address Line | 1875 CENTURY BLVD NE SUITE 150
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City | ATLANTA
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State | GA
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Zip | 30345-3319
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Country | US
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Telephone | 404-633-4595
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Fax |
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Provider Business Mailing Address
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Address Line | 1875 CENTURY BLVD NE #150
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City | ATLANTA
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State | GA
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Zip | 30345-3325
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Country | US
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Telephone | 404-633-4595
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 58821
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License Number State | GA
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