Provider Demographics
NPI:1033116934
Name:PATNI, ARIF (DO)
Entity Type:Individual
Prefix:DR
First Name:ARIF
Middle Name:
Last Name:PATNI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 742616
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-2616
Mailing Address - Country:US
Mailing Address - Phone:770-219-8420
Mailing Address - Fax:
Practice Address - Street 1:4445 S LEE ST
Practice Address - Street 2:SUITE 100
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-8804
Practice Address - Country:US
Practice Address - Phone:770-848-5200
Practice Address - Fax:770-848-5201
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA042916207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA598379OtherBLUE CROSS/BLUE SHIELD #
GA042916OtherGEORGIA MEDICAL LICENSE #
GA042916OtherGEORGIA MEDICAL LICENSE #
G54547Medicare UPIN
GA08LCCJFMedicare PIN
BP5183873OtherDEA REGISTRATION NUMBER