Provider Demographics
NPI:1730113945
Name:SHAH, FAUZIA RAFAT (MD)
Entity type:Individual
Prefix:
First Name:FAUZIA
Middle Name:RAFAT
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3495 PIEDMONT RD NE
Mailing Address - Street 2:NINE PIEDMONT CENTER
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-1717
Mailing Address - Country:US
Mailing Address - Phone:404-364-7070
Mailing Address - Fax:920-497-3753
Practice Address - Street 1:1000 JOHNSON FERRY RD
Practice Address - Street 2:NORTHSIDE HOSPITAL
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1606
Practice Address - Country:US
Practice Address - Phone:404-365-0966
Practice Address - Fax:920-797-3753
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI46476208M00000X
GA061518208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34474900Medicaid
07125-0276Medicare ID - Type Unspecified
WI34474900Medicaid