Provider Demographics
NPI:1811172570
Name:SHAH, MONAL KHANSAHEB (MD)
Entity type:Individual
Prefix:
First Name:MONAL
Middle Name:KHANSAHEB
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3030 OLD ATLANTA RD
Mailing Address - Street 2:STE 500
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-6939
Mailing Address - Country:US
Mailing Address - Phone:770-203-2000
Mailing Address - Fax:770-886-7903
Practice Address - Street 1:3030 OLD ATLANTA RD
Practice Address - Street 2:STE 500
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-6939
Practice Address - Country:US
Practice Address - Phone:770-203-2000
Practice Address - Fax:770-886-7903
Is Sole Proprietor?:No
Enumeration Date:2007-12-31
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA62536208000000X, 2080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA363160836MMedicaid