Provider Demographics
NPI:1114629136
Name:PATEL, PAYTON (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:PAYTON
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 COLONIAL PROMENADE PKWY
Mailing Address - Street 2:
Mailing Address - City:ALABASTER
Mailing Address - State:AL
Mailing Address - Zip Code:35007-3155
Mailing Address - Country:US
Mailing Address - Phone:205-605-0495
Mailing Address - Fax:
Practice Address - Street 1:120 COLONIAL PROMENADE PKWY
Practice Address - Street 2:
Practice Address - City:ALABASTER
Practice Address - State:AL
Practice Address - Zip Code:35007-3155
Practice Address - Country:US
Practice Address - Phone:205-605-0495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-21
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2122363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant