Provider Demographics
NPI:1043957376
Name:SHAH, MAHABIR SINGH (MD)
Entity type:Individual
Prefix:DR
First Name:MAHABIR
Middle Name:SINGH
Last Name:SHAH
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 MEMORIAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720
Mailing Address - Country:US
Mailing Address - Phone:706-226-8996
Mailing Address - Fax:706-272-6761
Practice Address - Street 1:1432 BROADRICK DRIVE
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720
Practice Address - Country:US
Practice Address - Phone:706-226-8990
Practice Address - Fax:706-529-5317
Is Sole Proprietor?:No
Enumeration Date:2022-05-18
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA390200000X
GA14276390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program