Provider Demographics
NPI:1770783417
Name:PATEL, AVANTIKA M (MD)
Entity type:Individual
Prefix:DR
First Name:AVANTIKA
Middle Name:M
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3495 PIEDMONT RD NE
Mailing Address - Street 2:THE SOUTHEAST PERMANENTE MEDICAL GROUP
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-1717
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1400 NORTHSIDE FORSYTH DR STE 350
Practice Address - Street 2:KAISER PERMANENTE FORSYTH
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-6018
Practice Address - Country:US
Practice Address - Phone:860-436-6189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT390200000Y207R00000X
GA061314207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine