Healthcare Provider Details

I. General information

NPI: 1508792979
Provider Name (Legal Business Name): MD PRIME INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3030 OLD ATLANTA RD STE 500
CUMMING GA
30041-5867
US

IV. Provider business mailing address

1774 MORNINGDALE CIR
DULUTH GA
30097-5260
US

V. Phone/Fax

Practice location:
  • Phone: 770-203-2000
  • Fax: 770-886-7903
Mailing address:
  • Phone: 404-944-5057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MONAL SHAH
Title or Position: OWNER
Credential: MD
Phone: 404-944-5057