MEDICARE: DR. TOM T SHIMABUKURO MD, MPH, MBA

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	2083P0901X	Public Health & General Preventive Medicine Physician	226907-1	NY

General Provider Information

NPI Number	:	1205863545
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TOM T SHIMABUKURO MD, MPH, MBA

Provider Business Mailing Address
First Line	:	704 BRIARHILL LN NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30324-5425
Country	:	US
Telephone Number	:	404-639-8542
Fax Number	:	404-639-8615

Provider Business Practice Location Address
First Line	:	1600 CLIFTON RD NE
Second Line	:	MS E-52
City	:	ATLANTA
State	:	GA
Zip	:	30329-4018
Country	:	US
Telephone Number	:	404-639-8542
Fax Number	:	404-639-8614

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

Provider Enumeration Date	:	06/26/2006
Last Update Date	:	07/08/2007

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