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General NPI Number Information
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NPI Number | 1508792979
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Entity Type | Organization
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Legal Business Name | MD PRIME INC
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Dates
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Enumeration Date | 06/22/2026
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Last Update Date | 06/22/2026
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Provider Practice Location Address
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Address Line | 3030 OLD ATLANTA RD STE 500
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City | CUMMING
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State | GA
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Zip | 30041-5867
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Country | US
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Telephone | 770-203-2000
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Fax | 770-886-7903
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Provider Business Mailing Address
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Address Line | 1774 MORNINGDALE CIR
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City | DULUTH
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State | GA
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Zip | 30097-5260
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Country | US
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Telephone | 404-944-5057
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MONAL SHAH
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Credential | MD
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Telephone | 404-944-5057
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0214X
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Taxonomy Name | Pediatric Pulmonology Physician
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License Number |
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License Number State |
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