Provider Demographics
NPI:1689957466
Name:PATEL, PURVITA AJITBHAI (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PURVITA
Middle Name:AJITBHAI
Last Name:PATEL
Suffix:
Gender:F
Credentials:PSYD
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 1916
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30133-1916
Mailing Address - Country:US
Mailing Address - Phone:678-977-8300
Mailing Address - Fax:866-489-2642
Practice Address - Street 1:6264 HOSPITAL WAY
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-1944
Practice Address - Country:US
Practice Address - Phone:678-977-8300
Practice Address - Fax:866-489-2642
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003496103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent