Provider Demographics
NPI:1356392039
Name:PATEL, PIYUSH I (MD)
Entity type:Individual
Prefix:
First Name:PIYUSH
Middle Name:I
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 1:605 OLD NORCROSS RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-4315
Mailing Address - Country:US
Mailing Address - Phone:770-962-1231
Mailing Address - Fax:770-962-1231
Practice Address - Street 1:605 OLD NORCROSS RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-4315
Practice Address - Country:US
Practice Address - Phone:770-962-1231
Practice Address - Fax:770-962-1231
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA57412174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist