Provider Demographics
NPI:1265798763
Name:PATEL, SULAY PANKAJ
Entity type:Individual
Prefix:
First Name:SULAY
Middle Name:PANKAJ
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 1:205 12TH ST NE APT 1411
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-4760
Mailing Address - Country:US
Mailing Address - Phone:432-978-1665
Mailing Address - Fax:
Practice Address - Street 1:101 WOODRUFF CIRCLE WMB 1013
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322
Practice Address - Country:US
Practice Address - Phone:404-686-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-09
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR7048207RC0000X
GA73778207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXR7084OtherTEXAS MEDICAL BOARD
GA073778OtherGEORGIA COMPOSITE MEDICAL BOARD