Provider Demographics
NPI:1821122060
Name:PATEL, SHAMA JITENDRA (OD)
Entity Type:Individual
Prefix:DR
First Name:SHAMA
Middle Name:JITENDRA
Last Name:PATEL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3777 PEACHTREE RD NE
Mailing Address - Street 2:#1533
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30319-3337
Mailing Address - Country:US
Mailing Address - Phone:205-835-6001
Mailing Address - Fax:
Practice Address - Street 1:2851 CANDLER RD
Practice Address - Street 2:SUITE 100
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-1412
Practice Address - Country:US
Practice Address - Phone:404-244-8377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002243152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist