Provider Demographics
NPI:1407849524
Name:PATEL, DIPAK B (MD)
Entity Type:Individual
Prefix:
First Name:DIPAK
Middle Name:B
Last Name:PATEL
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Gender:M
Credentials:MD
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Mailing Address - Street 1:4700 NELSON BROGDON BLVD
Mailing Address - Street 2:STE 180
Mailing Address - City:SUGARHILL
Mailing Address - State:GA
Mailing Address - Zip Code:30518-5400
Mailing Address - Country:US
Mailing Address - Phone:770-945-7676
Mailing Address - Fax:770-932-9845
Practice Address - Street 1:4700 NELSON BROGDON BLVD
Practice Address - Street 2:STE 180
Practice Address - City:SUGARHILL
Practice Address - State:GA
Practice Address - Zip Code:30518-5400
Practice Address - Country:US
Practice Address - Phone:770-945-7676
Practice Address - Fax:770-932-9845
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-24
Last Update Date:2024-02-12
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Provider Licenses
StateLicense IDTaxonomies
GA048174207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAH05458Medicare UPIN
GA08BBXFMMedicare ID - Type Unspecified