Provider Demographics
NPI:1407580350
Name:PATEL, SEMON G (DNP)
Entity Type:Individual
Prefix:
First Name:SEMON
Middle Name:G
Last Name:PATEL
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 OLD BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-1188
Mailing Address - Country:US
Mailing Address - Phone:912-805-0948
Mailing Address - Fax:
Practice Address - Street 1:464 BISHOP ST NW APT 506
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-4545
Practice Address - Country:US
Practice Address - Phone:912-805-0948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-14
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN280393363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily