Provider Demographics
NPI:1659556157
Name:DHIRAJ A PATEL MD
Entity Type:Organization
Organization Name:DHIRAJ A PATEL MD
Other - Org Name:ALPHA MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DHIRAJ
Authorized Official - Middle Name:A
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-772-4044
Mailing Address - Street 1:401 S MAIN ST
Mailing Address - Street 2:SUITE A-4
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-1974
Mailing Address - Country:US
Mailing Address - Phone:770-772-4044
Mailing Address - Fax:770-772-4227
Practice Address - Street 1:401 S MAIN ST
Practice Address - Street 2:SUITE A-4
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-1974
Practice Address - Country:US
Practice Address - Phone:770-772-4044
Practice Address - Fax:770-772-4227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GRP4579OtherMEDICARE GROUP NO