Provider Demographics
NPI:1285627505
Name:PATEL, ANJANA M (PA)
Entity Type:Individual
Prefix:
First Name:ANJANA
Middle Name:M
Last Name:PATEL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3850 PLEASANT HILL RD
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-4807
Mailing Address - Country:US
Mailing Address - Phone:770-814-8222
Mailing Address - Fax:678-205-5111
Practice Address - Street 1:3850 PLEASANT HILL RD
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-4807
Practice Address - Country:US
Practice Address - Phone:770-814-8222
Practice Address - Fax:678-205-5111
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3782363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA696237203FMedicaid
GA696237203AMedicaid
GA696237203EMedicaid
GA696237203BMedicaid
GA696237203DMedicaid
GA696237203EMedicaid
GAQ78199Medicare UPIN