Provider Demographics
NPI:1154716405
Name:SHAH, PRIYA GULATI (MD)
Entity type:Individual
Prefix:
First Name:PRIYA
Middle Name:GULATI
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2200 HIGHWAY 155 N STE 200
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30252-4846
Mailing Address - Country:US
Mailing Address - Phone:770-268-4011
Mailing Address - Fax:770-914-7703
Practice Address - Street 1:2200 HIGHWAY 155 N
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30252
Practice Address - Country:US
Practice Address - Phone:678-490-0341
Practice Address - Fax:678-490-0349
Is Sole Proprietor?:No
Enumeration Date:2015-04-03
Last Update Date:2018-08-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA80374207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine