Individual
MOBIN SHAH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1255 HIGHWAY 54 W, FAYETTEVILLE, GA 30214-4526
(770) 719-5609
(770) 719-5629
Mailing address
352 LANGSHIRE DR, MCDONOUGH, GA 30253-8055
(256) 457-4618
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
64068
GA
207R00000X
Internal Medicine Physician
64068
GA
208M00000X
Hospitalist Physician
Primary
064068
GA
208M00000X
Hospitalist Physician
64068
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102317534
—
PA
01
—
2109320
HIGHMARK BLUE SHIELD
PA
01
—
953138
CAREFIRST MD BCBS
MD
Enumeration date
05/23/2007
Last updated
03/25/2019
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