Provider Demographics
NPI:1447075403
Name:PEACH PEDIATRICS LLC
Entity type:Organization
Organization Name:PEACH PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MONAL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-944-5057
Mailing Address - Street 1:3030 OLD ATLANTA RD STE 500
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-5867
Mailing Address - Country:US
Mailing Address - Phone:770-203-2000
Mailing Address - Fax:770-886-7903
Practice Address - Street 1:3030 OLD ATLANTA RD STE 500
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-5867
Practice Address - Country:US
Practice Address - Phone:770-203-2000
Practice Address - Fax:770-886-7903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-15
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care