Provider Demographics
NPI:1063832756
Name:PATEL, JAYANTILAL
Entity Type:Individual
Prefix:
First Name:JAYANTILAL
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7140 SMOKEY HILL RD
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-4899
Mailing Address - Country:US
Mailing Address - Phone:615-491-3966
Mailing Address - Fax:
Practice Address - Street 1:7140 SMOKEY HILL RD
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-4899
Practice Address - Country:US
Practice Address - Phone:615-491-3966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-21
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver