Individual
EDWARD JOEL SHANIK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
260 ELM ST, CUMMING, GA 30040-2467
(770) 887-1668
(770) 781-9937
Mailing address
260 ELM ST, CUMMING, GA 30040-2467
(770) 887-1668
(770) 781-9937
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
020484
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000193179K
—
GA
05
—
000193179L
—
GA
05
—
000193179M
—
GA
05
—
00193179J
—
GA
01
—
01160889
AMERIGROUP
GA
05
—
4048222
—
TN
01
—
4186949
BCBS TN
TN
01
—
52023332
BCBS GA
GA
Enumeration date
03/23/2006
Last updated
12/22/2014
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