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General NPI Number Information
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NPI Number | 1992258313
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Entity Type | Individual
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Provider Name | JEFF SHIOVITZ
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Gender | Male
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Dates
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Enumeration Date | 08/02/2016
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Last Update Date | 08/02/2016
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Provider Practice Location Address
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Address Line | 4511 CHAMBLEE DUNWOODY RD SUITE A4
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City | ATLANTA
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State | GA
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Zip | 30338-6243
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Country | US
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Telephone | 770-392-8952
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Fax | 678-691-5341
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Provider Business Mailing Address
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Address Line | 4511 CHAMBLEE DUNWOODY ROAD SUITE A4
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City | ATLANTA
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State | GA
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Zip | 30338
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Country | US
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Telephone | 770-392-8952
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Fax | 678-691-5341
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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 | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 044-R-0095
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License Number State | GA
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