Provider Demographics
NPI:1699847616
Name:PATEL, MADHUBALA A (MD)
Entity Type:Individual
Prefix:MRS
First Name:MADHUBALA
Middle Name:A
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1401 APPLEWOOD DRIVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-2699
Mailing Address - Country:US
Mailing Address - Phone:706-270-5003
Mailing Address - Fax:706-270-5111
Practice Address - Street 1:900 SHUGART RD
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-2467
Practice Address - Country:US
Practice Address - Phone:706-270-5100
Practice Address - Fax:706-270-5066
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA0301812084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAF72735Medicare UPIN