Provider Demographics
NPI:1952784274
Name:JERATH, SHIVANI (MD)
Entity type:Individual
Prefix:DR
First Name:SHIVANI
Middle Name:
Last Name:JERATH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3275 N POINT PKWY STE 204
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-4708
Mailing Address - Country:US
Mailing Address - Phone:706-495-1928
Mailing Address - Fax:
Practice Address - Street 1:3275 N POINT PKWY STE 204
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4708
Practice Address - Country:US
Practice Address - Phone:706-495-1928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-06
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY296959207Q00000X
GA79638207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine