Provider Demographics
NPI:1164603676
Name:PATEL, MAYUR CHANDRAKANT (MD)
Entity Type:Individual
Prefix:
First Name:MAYUR
Middle Name:CHANDRAKANT
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:775 POPLAR RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-8300
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:775 POPLAR RD
Practice Address - Street 2:SUITE 130
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-8300
Practice Address - Country:US
Practice Address - Phone:770-683-6921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-27
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA069418207RC0200X, 207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3001358Medicaid
TNP00662735Medicare PIN
TN103I293173Medicare PIN
TN103I292857Medicare PIN
TNCL4949OtherMEDICARE RR
TN103I111148Medicare PIN
TN3001358Medicare PIN
FLGT578ZMedicare PIN
VA1164603676Medicaid
TNP0886735OtherMEDICARE RR