Provider Demographics
NPI:1750372561
Name:NOORANI, SHAHEEN P (MD)
Entity type:Individual
Prefix:DR
First Name:SHAHEEN
Middle Name:P
Last Name:NOORANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 BROADRICK DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-2676
Mailing Address - Country:US
Mailing Address - Phone:706-277-4799
Mailing Address - Fax:706-277-5054
Practice Address - Street 1:1210 BROADRICK DR
Practice Address - Street 2:SUITE 1
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-2676
Practice Address - Country:US
Practice Address - Phone:706-277-4799
Practice Address - Fax:706-277-5054
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-01
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA042678174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00744906CMedicaid
GA00744906CMedicaid
GA29BDCBJMedicare ID - Type Unspecified