Provider Demographics
NPI:1851399307
Name:PATEL, SUJAY G (MD)
Entity Type:Individual
Prefix:
First Name:SUJAY
Middle Name:G
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
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 1808
Mailing Address - Street 2:
Mailing Address - City:KINGSLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31548-1808
Mailing Address - Country:US
Mailing Address - Phone:912-729-4944
Mailing Address - Fax:912-729-9614
Practice Address - Street 1:39 ANDREWS WAY
Practice Address - Street 2:
Practice Address - City:KINGSLAND
Practice Address - State:GA
Practice Address - Zip Code:31548-6833
Practice Address - Country:US
Practice Address - Phone:912-729-4944
Practice Address - Fax:912-729-9614
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA50242208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
37BBGRJMedicare ID - Type Unspecified
H45523Medicare UPIN