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General NPI Number Information
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NPI Number | 1891744090
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Entity Type | Individual
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Provider Name | SHAHINA MIRZA MD
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Gender | Female
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Dates
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Enumeration Date | 05/08/2006
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Last Update Date | 11/18/2015
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Provider Practice Location Address
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Address Line | 445 WINN WAY
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City | DECATUR
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State | GA
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Zip | 30030-1707
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Country | US
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Telephone | 404-294-3835
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Fax | 404-508-7795
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Provider Business Mailing Address
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Address Line | 445 WINN WAY PO BOX 1648
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City | DECATUR
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State | GA
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Zip | 30030-1707
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Country | US
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Telephone | 404-294-3835
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Fax | 404-508-7795
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 027297
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 103TH0100X
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Taxonomy Name | Health Service Psychologist
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License Number |
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License Number State |
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