MEDICARE: DR. SHRENIK PANKAJ SHAH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	077245	GA
2	2085R0204X	Vascular & Interventional Radiology Physician	077245	GA

General Provider Information

NPI Number	:	1114168846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHRENIK PANKAJ SHAH M.D.

Provider Business Mailing Address
First Line	:	220 5TH AVE
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30030-4810
Country	:	US
Telephone Number	:	781-413-1186
Fax Number	:

Provider Business Practice Location Address
First Line	:	3885 PRINCETON LAKES WAY SW STE 314
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-7100
Country	:	US
Telephone Number	:	404-349-7770
Fax Number	:	404-349-7779

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2009
Last Update Date	:	08/22/2019

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