Provider Demographics
NPI:1093943722
Name:PATEL, MAMTA J (OD)
Entity Type:Individual
Prefix:DR
First Name:MAMTA
Middle Name:J
Last Name:PATEL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:6022 SPALDING PARK PL
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-7624
Mailing Address - Country:US
Mailing Address - Phone:770-362-4721
Mailing Address - Fax:
Practice Address - Street 1:5530 WINDWARD PKWY
Practice Address - Street 2:SUITE 1220
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-8969
Practice Address - Country:US
Practice Address - Phone:678-867-9868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-01
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002530152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist