Provider Demographics
NPI:1386670073
Name:PATEL, VAIBHAV VINUBHAI (MD)
Entity Type:Individual
Prefix:DR
First Name:VAIBHAV
Middle Name:VINUBHAI
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 1:2300 MANCHESTER EXPY STE 1001
Mailing Address - Street 2:BUTLER PAVILION
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-6802
Mailing Address - Country:US
Mailing Address - Phone:706-322-0528
Mailing Address - Fax:706-322-2080
Practice Address - Street 1:2300 MANCHESTER EXPY STE 1001
Practice Address - Street 2:BUTLER PAVILION
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-6802
Practice Address - Country:US
Practice Address - Phone:706-322-0528
Practice Address - Fax:706-322-2080
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA060025207RC0000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA887727511BMedicaid
GA887727511BMedicaid
GA202I062290Medicare PIN