Basic Information
| Provider Information | |||||||||
| NPI: | 1851754519 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHAPIRO | ||||||||
| FirstName: | SAMUEL | ||||||||
| MiddleName: | ELLIOT | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 655 DULUTH HWY STE 401 | ||||||||
| Address2: | |||||||||
| City: | LAWRENCEVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300467672 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6783120450 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 665 DULUTH HWY | ||||||||
| Address2: | 401 | ||||||||
| City: | LAWRENCEVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300463328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6783120450 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2016 | ||||||||
| LastUpdateDate: | 06/11/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 83247 | GA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.