NPIMap

Organization Active NPI

Peach Pediatrics LLC

  • Pediatrics Physician
  • Cumming, GA
National Provider Identifier
1447075403
Registry record updated Nov 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
PEACH PEDIATRICS LLC
Doing business as
Peach Pediatrics LLC
Practice address
3030 Old Atlanta Rd Ste 500
Cumming, GA 30041-5867
Phone
(770) 203-2000
Fax
(770) 886-7903
NPI assigned
Nov 15, 2024
Last updated
Nov 15, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2024

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

Authorized official

Name
Monal Shah, MDNPI 1811172570
Title
Owner
Phone
(404) 944-5057

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X NU
Pediatrics Physician 208000000X NU Primary

Addresses

Primary practice location

3030 Old Atlanta Rd Ste 500
Cumming, GA 30041-5867

Mailing address

3030 Old Atlanta Rd Ste 500
Cumming, GA 30041-5867
Phone (770) 203-2000

Other practice location 1

6010 Singleton Rd
Norcross, GA 30093-1963
Phone (770) 248-0200

Other names 1

  • Peach Pediatrics LLC 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
11D0700435Peach Pediatrics, LLC6010 Singleton Rd Suite 209, Norcross, GA 30093Certificate of waiverMar 15, 2028
11D2344280Peach Pediatrics, LLC3030 Old Atlanta Road, Suite #500, Cumming, GA 30041Certificate of waiverMay 19, 2028

National Provider Directory

National Provider Directory

Locations

3030 Old Atlanta Rd
Ste 500
Cumming, GA 30041
Phone (770) 203-1000

6010 Singleton Rd
Norcross, GA 30093
Phone (770) 248-0200

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1731628800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731628800000",
    "number": "1447075403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3030 OLD ATLANTA RD STE 500",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300415867",
            "telephone_number": "770-203-2000",
            "fax_number": "770-886-7903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3030 OLD ATLANTA RD STE 500",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300415867",
            "telephone_number": "770-203-2000",
            "fax_number": "770-886-7903"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6010 Singleton Rd",
            "address_purpose": "LOCATION",
            "city": "Norcross",
            "state": "GA",
            "postal_code": "300931963",
            "country_code": "US",
            "telephone_number": "770-248-0200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PEACH PEDIATRICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-11-15",
        "last_updated": "2024-11-15",
        "certification_date": "2024-11-15",
        "status": "A",
        "authorized_official_last_name": "SHAH",
        "authorized_official_first_name": "MONAL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "404-944-5057",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Peach Pediatrics LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cumming, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2024; 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.