Provider Demographics
NPI:1932134830
Name:PATEL, MANOJKUMAR CHANDULAL
Entity Type:Individual
Prefix:
First Name:MANOJKUMAR
Middle Name:CHANDULAL
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 ROWE ST
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-5238
Mailing Address - Country:US
Mailing Address - Phone:478-272-0353
Mailing Address - Fax:478-272-0363
Practice Address - Street 1:106 ROWE ST
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-5238
Practice Address - Country:US
Practice Address - Phone:478-272-0353
Practice Address - Fax:478-272-0363
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA056910207R00000X
PAMD417056207R00000X
NY228488207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA343159815BMedicaid
GA511I110280Medicare PIN
GA343159815BMedicaid