MEDICARE: SAMAD 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	A154744	CA
2	390200000X	Student in an Organized Health Care Education/Training Program
3	2085R0202X	Diagnostic Radiology Physician	94333	GA

General Provider Information

NPI Number	:	1356787840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMAD SHAH M.D.

Provider Business Mailing Address
First Line	:	2201 HENDERSON MILL RD NE STE 160
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30345-2711
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2201 HENDERSON MILL RD NE STE 160
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30345-2711
Country	:	US
Telephone Number	:	404-778-4889
Fax Number	:

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

Provider Enumeration Date	:	05/11/2013
Last Update Date	:	01/09/2023

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