Provider Demographics
NPI:1245393511
Name:PATEL, AMISH N (MD)
Entity Type:Individual
Prefix:MR
First Name:AMISH
Middle Name:N
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 1:3495 PIEDMONT RD NE
Mailing Address - Street 2:NINE PIEDMONT CENTER
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-1717
Mailing Address - Country:US
Mailing Address - Phone:404-364-7070
Mailing Address - Fax:
Practice Address - Street 1:2470 MOUNT ZION PKWY
Practice Address - Street 2:KAISER PERMANENTE SOUTHWOOD SPECIALTY CENTER
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-2500
Practice Address - Country:US
Practice Address - Phone:404-364-7070
Practice Address - Fax:866-232-0314
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-113371207R00000X
GAGA061994207RN0300X
GA061994207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGA061994OtherLICENSE
GA852530549EMedicaid
GA852530549HMedicaid
GA852530549JMedicaid
GA852530549MMedicaid
GA852530549ZMedicaid
GA852530549IMedicaid
GA852530549BMedicaid
GA852530549PMedicaid
GA852530549AAMedicaid
GA852530549CMedicaid
GA852530549SMedicaid
GA852530549YMedicaid
GA852530549DMedicaid
GA852530549LMedicaid
GAGA061994OtherLICENSE
GA852530549FMedicaid
GA852530549GMedicaid
GA852530549NMedicaid
GA852530549TMedicaid
GA852530549XMedicaid
GA852530549OMedicaid