Provider Demographics
NPI:1679641831
Name:PATEL, RIMA B
Entity Type:Individual
Prefix:DR
First Name:RIMA
Middle Name:B
Last Name:PATEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 OLD ATLANTA HWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-4751
Mailing Address - Country:US
Mailing Address - Phone:770-251-6868
Mailing Address - Fax:770-683-6872
Practice Address - Street 1:23 OLD ATLANTA HWY
Practice Address - Street 2:SUITE 200
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-4751
Practice Address - Country:US
Practice Address - Phone:770-251-6868
Practice Address - Fax:770-683-6872
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0129791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice