MEDICARE: SHUBHI GOYAL GOLI 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	208000000X	Pediatrics Physician	A168595	CA
2	2080P0204X	Pediatric Emergency Medicine (Pediatrics) Physician	100440	GA
3	208000000X	Pediatrics Physician	MT210903	PA

General Provider Information

NPI Number	:	1174973960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHUBHI GOYAL GOLI M.D.

Provider Business Mailing Address
First Line	:	1547 CLIFTON ROAD
Second Line	:	2ND FLOOR
City	:	ATLANTA
State	:	GA
Zip	:	30322-4008
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1547 CLIFTON RD NE FL 2
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30322-1809
Country	:	US
Telephone Number	:	404-785-7189
Fax Number	:

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

Provider Enumeration Date	:	06/13/2016
Last Update Date	:	06/15/2024

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