Provider Demographics
NPI:1447213772
Name:PATEL, THAKORBHAI (MD)
Entity Type:Individual
Prefix:
First Name:THAKORBHAI
Middle Name:
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:PO BOX 155
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30168-1002
Mailing Address - Country:US
Mailing Address - Phone:770-732-3649
Mailing Address - Fax:770-732-3648
Practice Address - Street 1:3950 AUSTELL RD
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106
Practice Address - Country:US
Practice Address - Phone:770-732-3649
Practice Address - Fax:770-732-3648
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-08
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA019579207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000150026BMedicaid
GA05BDBXJMedicare ID - Type Unspecified
GA000150026BMedicaid