Provider Demographics
NPI:1336123439
Name:PATEL, VIJAY M (MD)
Entity Type:Individual
Prefix:
First Name:VIJAY
Middle Name:M
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
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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:770-683-6921
Mailing Address - Fax:770-254-6037
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:770-254-6037
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2013-08-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA035723207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA035723OtherGA LICENSE
GA000709838EMedicaid
GA202I296122Medicare PIN
GAG34204Medicare UPIN