Provider Demographics
NPI:1336523166
Name:PATEL, JALPA R (DPM)
Entity Type:Individual
Prefix:
First Name:JALPA
Middle Name:R
Last Name:PATEL
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1975 HIGHWAY 54 W
Mailing Address - Street 2:STE 205
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-4794
Mailing Address - Country:US
Mailing Address - Phone:678-561-9000
Mailing Address - Fax:770-415-1450
Practice Address - Street 1:1716 CLEVELAND HWY
Practice Address - Street 2:SUITE 104
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30721-2314
Practice Address - Country:US
Practice Address - Phone:706-259-6882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-10
Last Update Date:2017-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD001276213E00000X
PASC006530213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist