Provider Demographics
NPI:1720604556
Name:PATEL, RIMA DIPAK (ADVANCED PRACTICE NP)
Entity Type:Individual
Prefix:
First Name:RIMA
Middle Name:DIPAK
Last Name:PATEL
Suffix:
Gender:F
Credentials:ADVANCED PRACTICE NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 857
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-0029
Mailing Address - Country:US
Mailing Address - Phone:404-789-0452
Mailing Address - Fax:
Practice Address - Street 1:310 PHILIP BLVD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-8700
Practice Address - Country:US
Practice Address - Phone:678-971-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-17
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN232106207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine