Provider Demographics
NPI:1851378186
Name:PATEL, ALPA B (DPM)
Entity Type:Individual
Prefix:
First Name:ALPA
Middle Name:B
Last Name:PATEL
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 CHECKERED WAY NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152
Mailing Address - Country:US
Mailing Address - Phone:770-596-2376
Mailing Address - Fax:706-232-6750
Practice Address - Street 1:101 JOHN MADDOX DR NW STE A
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-1419
Practice Address - Country:US
Practice Address - Phone:706-232-6739
Practice Address - Fax:706-232-6750
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2017-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003019P213E00000X
GAPOD001000213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2019685Medicaid
GA5545450001Medicare NSC
OHU67215Medicare UPIN
OHPA0831611Medicare ID - Type Unspecified