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General NPI Number Information
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NPI Number | 1871336669
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Entity Type | Organization
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Legal Business Name | 360 UROLOGY
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Dates
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Enumeration Date | 06/18/2024
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Last Update Date | 07/26/2024
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Provider Practice Location Address
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Address Line | 175 COUNTRY CLUB DR STE 300-E
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-9054
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Country | US
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Telephone | 678-941-4140
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Fax | 678-941-4139
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Provider Business Mailing Address
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Address Line | 175 COUNTRY CLUB DR STE 300-E
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-9054
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Country | US
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Telephone | 678-941-4140
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Fax | 678-941-4139
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Authorized Official
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Title or Position | OWNER
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Name | DR. BHAVIK B SHAH
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Credential | MD
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Telephone | 813-842-5956
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State |
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