Provider Demographics
NPI:1215039029
Name:PATEL, KARTIKEYA P (MD)
Entity Type:Individual
Prefix:
First Name:KARTIKEYA
Middle Name:P
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:601 OLD NORCROSS RD
Mailing Address - Street 2:STE A
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-4311
Mailing Address - Country:US
Mailing Address - Phone:770-963-2474
Mailing Address - Fax:770-963-2476
Practice Address - Street 1:601 OLD NORCROSS RD
Practice Address - Street 2:STE A
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-4311
Practice Address - Country:US
Practice Address - Phone:770-963-2474
Practice Address - Fax:770-963-2476
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA43258207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA11BDLXJMedicare ID - Type Unspecified
GAG45206Medicare UPIN