Provider Demographics
NPI:1326446873
Name:PATEL, KINNA ASHOK (DPM)
Entity Type:Individual
Prefix:DR
First Name:KINNA
Middle Name:ASHOK
Last Name:PATEL
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 POWDER SPRINGS ST STE B6
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-3559
Mailing Address - Country:US
Mailing Address - Phone:561-293-5288
Mailing Address - Fax:
Practice Address - Street 1:540 POWDER SPRINGS ST STE B6
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-3559
Practice Address - Country:US
Practice Address - Phone:561-293-5288
Practice Address - Fax:770-702-8809
Is Sole Proprietor?:No
Enumeration Date:2014-12-16
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY245179213E00000X
FLPO3693213E00000X
GAPOD001435213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5745931OtherAETNA
FL650AVOtherBLUE CROSS BLUE SHIELD