Provider Demographics
NPI:1861534000
Name:SHAH, PURVI K (PA)
Entity type:Individual
Prefix:
First Name:PURVI
Middle Name:K
Last Name:SHAH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2628
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-2628
Mailing Address - Country:US
Mailing Address - Phone:706-364-5500
Mailing Address - Fax:706-364-6863
Practice Address - Street 1:800 OAKHURST DR
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3650
Practice Address - Country:US
Practice Address - Phone:706-364-5500
Practice Address - Fax:706-364-6863
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004989363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant