NPIMap

Organization Active NPI

Kennesaw Wellness

Doing business as Prime Health MD

  • Adult Medicine Physician
  • Kennesaw, GA
National Provider Identifier
1184304404
Registry record updated Jul 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Medicine PhysicianTaxonomy code 207QA0505X
Legal business name
KENNESAW WELLNESS
Doing business as
Prime Health MD
Practice address
745 Chastain Rd NW Ste 1060
Kennesaw, GA 30144-3002
Phone
(770) 800-3353
Fax
(770) 575-8361
NPI assigned
Jul 21, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Niraj Patel, MDNPI 1932145422
Title
Owner
Phone
(804) 814-7666

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207QA0505X Primary

Addresses

Primary practice location

745 Chastain Rd NW Ste 1060
Kennesaw, GA 30144-3002

Mailing address

4505 Ashford Dunwoody Rd NE Ste 15B
Dunwoody, GA 30346-1516

Other names 1

  • Prime Health MD Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D2309352Kennesaw Wellness Dba Primehealthmd745 Chastain Road, NW, Suite 1060, Kennesaw, GA 30144Certificate of waiverAug 13, 2026

National Provider Directory

National Provider Directory

Locations

745 Chastain Rd NW
Ste 1060
Kennesaw, GA 30144
Phone (470) 450-4156

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 16

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1689897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689897600000",
    "number": "1184304404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4505 ASHFORD DUNWOODY RD NE STE 15B",
            "city": "DUNWOODY",
            "state": "GA",
            "postal_code": "303461516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "745 CHASTAIN RD NW STE 1060",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301443002",
            "telephone_number": "770-800-3353",
            "fax_number": "770-575-8361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNESAW WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-21",
        "last_updated": "2023-07-21",
        "certification_date": "2023-07-21",
        "status": "A",
        "authorized_official_last_name": "PATEL",
        "authorized_official_first_name": "NIRAJ",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "804-814-7666",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine, Adult Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Prime Health MD",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kennesaw, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.