Provider Demographics
NPI:1417985730
Name:PATEL, BHAVESH A (MD)
Entity Type:Individual
Prefix:
First Name:BHAVESH
Middle Name:A
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2704 N OAK ST
Mailing Address - Street 2:BUILDING B-3
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1744
Mailing Address - Country:US
Mailing Address - Phone:229-257-0100
Mailing Address - Fax:229-257-0050
Practice Address - Street 1:2704 N OAK ST
Practice Address - Street 2:BUILDING B-3
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1744
Practice Address - Country:US
Practice Address - Phone:229-257-0100
Practice Address - Fax:229-257-0050
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2020-09-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA0561632084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA118324078AMedicaid
GA118324078AMedicaid
GAI35459Medicare UPIN