Provider Demographics
NPI:1861997462
Name:ANWAR, SHAYAN SHUJA (DO)
Entity type:Individual
Prefix:DR
First Name:SHAYAN
Middle Name:SHUJA
Last Name:ANWAR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2518 JIMMY LEE SMITH PKWY
Mailing Address - Street 2:
Mailing Address - City:HIRAM
Mailing Address - State:GA
Mailing Address - Zip Code:30141-2068
Mailing Address - Country:US
Mailing Address - Phone:470-644-8027
Mailing Address - Fax:470-985-7105
Practice Address - Street 1:2518 JIMMY LEE SMITH PKWY
Practice Address - Street 2:
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141-2068
Practice Address - Country:US
Practice Address - Phone:470-644-8027
Practice Address - Fax:470-985-7105
Is Sole Proprietor?:No
Enumeration Date:2018-03-26
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAVA0116031889207Q00000X
VA0102205766207Q00000X
NC2021-01731207Q00000X, 208M00000X
GA94970208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine