Provider Demographics
NPI:1740613876
Name:PATEL, GEMMA KHUSHBOO
Entity Type:Individual
Prefix:DR
First Name:GEMMA
Middle Name:KHUSHBOO
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 1:4600 ROSWELL RD
Mailing Address - Street 2:SUITE D120
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-3075
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4600 ROSWELL RD
Practice Address - Street 2:SUITE D120
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-3075
Practice Address - Country:US
Practice Address - Phone:678-437-8143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-13
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002785152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist