Provider Demographics
NPI:1316123169
Name:SHAH, RESHMA PRADIP (MD)
Entity type:Individual
Prefix:
First Name:RESHMA
Middle Name:PRADIP
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3939 ROSWELL RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-6251
Mailing Address - Country:US
Mailing Address - Phone:678-403-4300
Mailing Address - Fax:770-971-7721
Practice Address - Street 1:3747 ROSWELL RD STE 202
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-6227
Practice Address - Country:US
Practice Address - Phone:678-403-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-10
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA066065207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine