Provider Demographics
NPI:1639498181
Name:PATEL, SHITAL (MD)
Entity Type:Individual
Prefix:
First Name:SHITAL
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 1:1000 TOWNE CENTER BLVD STE 604
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-4070
Mailing Address - Country:US
Mailing Address - Phone:912-561-7001
Mailing Address - Fax:912-561-7002
Practice Address - Street 1:1000 TOWNE CENTER BLVD STE 604
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-4070
Practice Address - Country:US
Practice Address - Phone:912-561-7001
Practice Address - Fax:912-561-7002
Is Sole Proprietor?:No
Enumeration Date:2010-05-24
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA073776208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist