Provider Demographics
NPI:1962459222
Name:PATEL, HAMANT B (MD)
Entity Type:Individual
Prefix:
First Name:HAMANT
Middle Name:B
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 1:305 OSIGIAN BLVD
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-8953
Mailing Address - Country:US
Mailing Address - Phone:478-953-9999
Mailing Address - Fax:478-953-7910
Practice Address - Street 1:305 OSIGIAN BLVD
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-8953
Practice Address - Country:US
Practice Address - Phone:478-953-9999
Practice Address - Fax:478-953-7910
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA043738207VG0400X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000751561EMedicaid
GA000751561BMedicaid
GA202I165080Medicare PIN
G54716Medicare UPIN
GA000751561EMedicaid
GA000751561BMedicaid
GAGRP4917Medicare PIN