DR. MRINAL SHUKLA (NPI# 1912297557) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1912297557 |
| Entity Type | Individual |
| Full Name | DR. MRINAL SHUKLA |
| Credential | M.D. |
| Practice Address |
1120 15th St # Ba-4411 Augusta GA 30912 |
| Mailing Address |
1120 15th St # Bi-1056 Augusta GA 30912-0004 |
| Practice Telephone | 7067211606 |
| Practice Fax Number | 7067211940 |
| Mailing Telephone | 7068288401 |
| Mailing Fax Number | 7067219286 |
| Enumeration Date | 2011-04-16 |
| Last Update Date | 2018-07-05 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2086S0129X |
Surgery Specialization: Vascular Surgery |
080579 | GA | Allopathic & Osteopathic Physicians |
| Street Address |
1120 15TH ST # BA-4411 |
| City | AUGUSTA |
| State | GA |
| Zip Code | 30912 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285857391 | Adil M Abuzeid | Surgery | 1120 15th St # Ba-4411, Georgia Regents Medical Associates, Augusta, GA 30912-0004 | 2007-04-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548885940 | Hannah Gullickson Folsom | Family Medicine | 1459 Laney Walker Blvd Ae 3042, Augusta, GA 30912 | 2020-06-11 |
| 1487278909 | Robert Kennedy | Internal Medicine | Augusta University Internal Medicine Residency Program, 1120 15th Street, Bi 5070, Augusta, GA 30912 | 2020-06-01 |
| 1952968737 | Kayla M. Lasota | Pediatrics | 11230 115th St Ae3042, Augusta, GA 30912 | 2019-05-28 |
| 1003379280 | Kayla Cox | Internal Medicine | 1120 15th St Bi5070, Augusta, GA 30912 | 2019-04-13 |
| 1619435740 | Justin Ray Mackert | Student in an Organized Health Care Education/Training Program | Augusta University, 1120 15th Street, Gc 5110, Augusta, GA 30912 | 2019-03-07 |
| 1417444167 | Victor Celis | Dentist | John Wesley Gilbert Dr, Augusta, GA 30912 | 2018-04-18 |
| 1487157921 | Julie Ann Matsen | Student in an Organized Health Care Education/Training Program | 997 St. Sebastian Way, Eg-2021-10, Augusta Univ., Dept. of Psychiatry & Health Behavior, Augusta, GA 30912 | 2018-03-12 |
| 1497287031 | Luke Yuung-jier Chang | Ophthalmology | 1120 15th St # Ba2720, Augusta, GA 30912 | 2017-04-02 |
| 1821537622 | Lashawn Kay Boone | Nurse Practitioner | 1445 Harper St, Augusta, GA 30912 | 2017-02-14 |
| 1134675564 | Arnab Saha | Internal Medicine | 1120 15 Th St., Augusta, GA 30912 | 2016-08-26 |
| Find all providers in zip 30912 | ||||
| Taxonomy Code | 2086S0129X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Vascular Surgery |
| A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881863793 | Luis Suarez Jr. | Surgery | 2233 Richards Rd, Augusta, GA 30906-2837 | 2008-02-25 |
| 1659587269 | Charles Herman Wray | Surgery | 3115 Ramsgate Rd, Augusta, GA 30909-3323 | 2007-05-14 |
| 1386056752 | Michael N Neilson | Surgery | 35 Medical Center Pkwy, Augusta, ME 04330-8160 | 2014-05-20 |
| 1083930812 | Alison Folger Ward | Surgery | 1120 15th St, Augusta, GA 30912-0004 | 2010-04-19 |
| 1265668271 | Steven M. Roth, M.d., P.C. | Surgery | 2101 Central Ave, Augusta, GA 30904-6706 | 2009-06-04 |
| 1104051754 | University Vascular Specialist, Inc. | Surgery | 818 Saint Sebastian Way, Suite 408, Augusta, GA 30901-2651 | 2009-05-27 |
| 1588829055 | Aaron Michael Hurd | Surgery | 630 13th St, Suite 250, Augusta, GA 30901-1015 | 2008-07-24 |
| 1689867897 | William S Hiltz | Surgery | 630 13th Street, Suite 250, Augusta, GA 30901-1017 | 2007-08-21 |
| 1932303815 | John Thomas Frederick | Surgery | 630 13th St, Suite 250, Augusta, GA 30901-1015 | 2007-06-13 |
| 1609096585 | Houman Tamaddon | Surgery | 1350 Walton Way, Augusta, GA 30901-2612 | 2007-04-26 |
| Find all providers in AUGUSTA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.