Provider Demographics
NPI:1730576364
Name:SHETH, USHMA
Entity type:Individual
Prefix:
First Name:USHMA
Middle Name:
Last Name:SHETH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1075 WHITLOCK AVE SW STE I
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-1996
Mailing Address - Country:US
Mailing Address - Phone:678-215-1882
Mailing Address - Fax:
Practice Address - Street 1:1075 WHITLOCK AVE SW STE I
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-1996
Practice Address - Country:US
Practice Address - Phone:678-215-1882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-21
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC006957213E00000X
GAPOD001451213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist