Individual
SHIRA AMDUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3950 AUSTELL RD, AUSTELL, GA 30106
(770) 793-7899
Mailing address
3950 AUSTELL RD, AUSTELL, GA 30106-1121
(770) 793-7899
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Q5963
TX
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
Primary
82667
GA
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
Q5963
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
363246501
—
TX
Enumeration date
03/26/2012
Last updated
10/03/2019
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