Provider Demographics
NPI:1417031428
Name:PATEL, BHAVDIPKUMAR G (MD)
Entity Type:Individual
Prefix:
First Name:BHAVDIPKUMAR
Middle Name:G
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 1:1320 S MADISON AVE
Mailing Address - Street 2:#269
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31533
Mailing Address - Country:US
Mailing Address - Phone:912-383-8070
Mailing Address - Fax:912-383-0509
Practice Address - Street 1:1020 WARD ST EXT W
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-2204
Practice Address - Country:US
Practice Address - Phone:912-383-8070
Practice Address - Fax:912-383-0509
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA048694207RS0012X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA58786975001OtherBCBS
GA000907684AMedicaid
GA000907684AMedicaid
GA58786975001OtherBCBS