MEDICARE: STEVEN LEWIS SHORE MD

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	2080P0208X	Pediatric Infectious Diseases Physician	015611	GA
2	208000000X	Pediatrics Physician	015611	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699706184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN LEWIS SHORE MD

Provider Business Mailing Address
First Line	:	1200 LAKE HEARN DR
Second Line	:	STE 275
City	:	ATLANTA
State	:	GA
Zip	:	30319
Country	:	US
Telephone Number	:	470-993-6287
Fax Number	:	470-961-7300

Provider Business Practice Location Address
First Line	:	1200 LAKE HEARN DR NE STE 275
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30319-1411
Country	:	US
Telephone Number	:	470-993-6287
Fax Number	:	470-961-7300

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

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	04/08/2026

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