Provider Demographics
NPI:1497856777
Name:PATEL, BHARATKUMAR C (MD)
Entity Type:Individual
Prefix:DR
First Name:BHARATKUMAR
Middle Name:C
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4015 S COBB DR SE STE 110
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-6316
Mailing Address - Country:US
Mailing Address - Phone:770-432-9292
Mailing Address - Fax:770-432-1110
Practice Address - Street 1:4015 S COBB DR SE STE 110
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-6316
Practice Address - Country:US
Practice Address - Phone:770-432-9292
Practice Address - Fax:770-432-1110
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0486932084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00878545AMedicaid
GAH15925Medicare UPIN
GA26BDHFJMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER