MEDICARE: DIMPLE D. 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	207R00000X	Internal Medicine Physician	059329	GA
2	207R00000X	Internal Medicine Physician	ME105115	FL

General Provider Information

NPI Number	:	1740486976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIMPLE D. SHAH M.D.

Provider Business Mailing Address
First Line	:	137 JOHNSON FERRY RD
Second Line	:	SUITE 1200
City	:	MARIETTA
State	:	GA
Zip	:	30068-4945
Country	:	US
Telephone Number	:	404-251-1912
Fax Number	:	678-843-9650

Provider Business Practice Location Address
First Line	:	137 JOHNSON FERRY RD
Second Line	:	SUITE 1200
City	:	MARIETTA
State	:	GA
Zip	:	30068-4945
Country	:	US
Telephone Number	:	404-251-1912
Fax Number	:	678-843-9650

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

Provider Enumeration Date	:	06/25/2007
Last Update Date	:	10/05/2015

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