Provider Demographics
NPI:1669730453
Name:PATEL, MISTI BENTON (MD)
Entity type:Individual
Prefix:DR
First Name:MISTI
Middle Name:BENTON
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 PINE ST STE 990
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-7500
Mailing Address - Country:US
Mailing Address - Phone:478-633-0404
Mailing Address - Fax:478-633-0805
Practice Address - Street 1:840 PINE ST STE 990
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-7500
Practice Address - Country:US
Practice Address - Phone:478-633-0404
Practice Address - Fax:478-633-0805
Is Sole Proprietor?:No
Enumeration Date:2012-04-30
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA75341207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program