Active NPI
David W. Shonkoff, MD
- Cardiovascular Disease Physician
- Lawrenceville, GA
National Provider Identifier
1265428692
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Cardiovascular Disease Physician
- License
- 24494
- Practice address
- 755 Walther Rd
Lawrenceville, GA 30045-8725 - Phone
- (770) 962-0399
- Fax
- (678) 252-3720
- NPI assigned
- Sep 21, 2005
- Last updated
- Jul 5, 2010
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cardiovascular Disease Physician | 207RC0000X | 24494 | GA | Primary |
| Nuclear Cardiology Physician | 207UN0901X | 24494 | GA |
Addresses
Primary practice location
755 Walther Rd
Lawrenceville, GA 30045-8725
Mailing address
755 Walther Rd
Lawrenceville, GA 30046-8725
Phone (770) 962-0399
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00268881B | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 24494 | GA | MD | Cardiovascular Disease Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gwinnett Pathology Assoc PC | Current | Accepting new patients | |
| Gwinnett Cardiology Services LLC | Cardiovascular Disease | Current | Accepting new patients |
| Gwinnett Medical Group, Inc | Current | Accepting new patients | |
| Cardiovascular Group, PC | Cardiovascular Disease | Past | Accepting new patients |
| Emory Specialty Associates, LLC | Past | Accepting new patients |
Locations
1000 Medical Center Blvd
Lawrenceville, GA 30046
Phone (678) 312-3356
755 Walther Rd
Lawrenceville, GA 30046
1700 Medical Way
Snellville, GA 30078
Phone (770) 978-4229
Organizations & group practices 5
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Cardiovascular Disease Physician
- Lawrenceville, GA
- NPI 1306185491
-
- General Practice Physician
- Lawrenceville, GA
- NPI 1780747469
-
- Anatomic Pathology & Clinical Pathology Physician
- Lawrenceville, GA
- NPI 1104887330
-
- Cardiovascular Disease Physician
- Lawrenceville, GA
- NPI 1215980479
-
- Anesthesiology Physician
- Lagrange, GA
- NPI 1407864168
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1127260800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1278288000000",
"number": "1265428692",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "755 WALTHER RD",
"city": "LAWRENCEVILLE",
"state": "GA",
"postal_code": "300468725",
"telephone_number": "770-962-0399",
"fax_number": "678-252-3720"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "755 WALTHER RD",
"city": "LAWRENCEVILLE",
"state": "GA",
"postal_code": "300458725",
"telephone_number": "770-962-0399",
"fax_number": "678-252-3720"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHONKOFF",
"first_name": "DAVID",
"middle_name": "W.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-09-21",
"last_updated": "2010-07-05",
"status": "A"
},
"taxonomies": [
{
"code": "207RC0000X",
"taxonomy_group": "",
"desc": "Internal Medicine, Cardiovascular Disease",
"state": "GA",
"license": "24494",
"primary": true
},
{
"code": "207UN0901X",
"taxonomy_group": "",
"desc": "Nuclear Medicine, Nuclear Cardiology",
"state": "GA",
"license": "24494",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00268881B",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Lawrenceville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.