Provider Demographics
NPI:1497383871
Name:SHOAI, BANAFSHEH BONNIE (MD)
Entity type:Individual
Prefix:
First Name:BANAFSHEH
Middle Name:BONNIE
Last Name:SHOAI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 PIEDMONT AVE NE APT 313
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-4406
Mailing Address - Country:US
Mailing Address - Phone:404-326-1888
Mailing Address - Fax:
Practice Address - Street 1:315 WINN WAY
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-2111
Practice Address - Country:US
Practice Address - Phone:404-299-9724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-31
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA100615207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology