NPIMap

Organization Active NPI

Shubhang Mazumdar MD

  • Internal Medicine Physician
  • Marietta, GA
National Provider Identifier
1477608016
Registry record updated Oct 27, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
19297 Issued in GA
Legal business name
SHUBHANG MAZUMDAR MD
Practice address
2550 Windy Hill Rd SE Ste 309
Marietta, GA 30067-8655
Phone
(770) 951-1565
Fax
(770) 988-0563
NPI assigned
Jan 24, 2007
Last updated
Oct 27, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Helen Chang
Title
Billing Person
Phone
(770) 952-2048

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X 19297 GA Primary

Addresses

Primary practice location

2550 Windy Hill Rd SE Ste 309
Marietta, GA 30067-8655

Mailing address

2550 Windy Hill Rd SE Ste 309
Marietta, GA 30067-8655
Phone (770) 951-1565

Other identifiers 3

IdentifierTypeStateIssuer
GRP2975OtherGAMEDICARE GROUP NUMBER
00266791CMedicaidGA
DD5386OtherGARAILROAD MEDICARE GROUP NUMBER

National Provider Directory

National Provider Directory

Locations

2550 Windy Hill Rd SE
Ste 309
Marietta, GA 30067
Phone (770) 951-1565

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1288137600000",
    "number": "1477608016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2550 WINDY HILL RD SE STE 309",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300678655",
            "telephone_number": "770-951-1565",
            "fax_number": "770-988-0563"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2550 WINDY HILL RD SE STE 309",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300678655",
            "telephone_number": "770-951-1565",
            "fax_number": "770-988-0563"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHUBHANG MAZUMDAR MD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-24",
        "last_updated": "2010-10-27",
        "status": "A",
        "authorized_official_last_name": "CHANG",
        "authorized_official_first_name": "HELEN",
        "authorized_official_title_or_position": "BILLING PERSON",
        "authorized_official_telephone_number": "770-952-2048",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "19297",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP NUMBER",
            "identifier": "GRP2975",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00266791C",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE GROUP NUMBER",
            "identifier": "DD5386",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 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.

Verify at the official NPI Registry.