Active NPI
Bhavik P Shah, D.D.S.
- Endodontics
- Fayetteville, GA
National Provider Identifier
1003980020
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 12417
- Practice address
- 1240 Highway 54 W Ste 315
Fayetteville, GA 30214-4572 - Phone
- (770) 478-6878
- Fax
- (770) 478-4642
- NPI assigned
- Nov 20, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 12417 | GA | Primary |
Addresses
Primary practice location
1240 Highway 54 W Ste 315
Fayetteville, GA 30214-4572
Mailing address
1240 Highway 54 W Ste 315
Fayetteville, GA 30214-4572
Phone (770) 478-6878
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150619000514 | GA | Order and Referring Only - Other (Non-Physician) | 6507177342 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12417 | GA | MD | Anesthesiologist Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163980800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1491264000000",
"number": "1003980020",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1240 HIGHWAY 54 W STE 315",
"city": "FAYETTEVILLE",
"state": "GA",
"postal_code": "302144572",
"telephone_number": "770-478-6878",
"fax_number": "770-478-4642"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1240 HIGHWAY 54 W STE 315",
"city": "FAYETTEVILLE",
"state": "GA",
"postal_code": "302144572",
"telephone_number": "770-478-6878",
"fax_number": "770-478-4642"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAH",
"first_name": "BHAVIK",
"middle_name": "P",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-20",
"last_updated": "2017-04-04",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "GA",
"license": "12417",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fayetteville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.