Provider Demographics
NPI:1902398282
Name:PATEL, PARTH KIRITKUMAR (MD)
Entity Type:Individual
Prefix:
First Name:PARTH
Middle Name:KIRITKUMAR
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 1:3400 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-2513
Mailing Address - Country:US
Mailing Address - Phone:478-474-5600
Mailing Address - Fax:478-471-6769
Practice Address - Street 1:3400 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-2513
Practice Address - Country:US
Practice Address - Phone:478-474-5600
Practice Address - Fax:478-471-6769
Is Sole Proprietor?:No
Enumeration Date:2018-06-03
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA010545207Q00000X
390200000X
GA89948207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program