Basic Information
| Provider Information | |||||||||
| NPI: | 1851433320 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NAIM G. SHAHEED, DPM, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5910 HILLANDALE DRIVE | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | LITHONIA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300581877 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709819011 | ||||||||
| FaxNumber: | 7709810480 | ||||||||
| Practice Location | |||||||||
| Address1: | 5910 HILLANDALE DRIVE | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | LITHONIA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300581877 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709819011 | ||||||||
| FaxNumber: | 7709810480 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2007 | ||||||||
| LastUpdateDate: | 08/16/2011 | ||||||||
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| AuthorizedOfficialLastName: | SHAHEED | ||||||||
| AuthorizedOfficialFirstName: | NAIM | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO | ||||||||
| AuthorizedOfficialTelephone: | 7709819011 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DPM, P.C. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | N | 193200000X MULTI-SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery | 213ES0131X | 000637 | GA | Y | 193200000X MULTI-SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot Surgery |
ID Information
| ID | Type | State | Issuer | Description | 000536313B | 05 | GA | MEDICAID |