Provider Demographics
NPI:1780619460
Name:PATEL, DILIPKMAR C (MD)
Entity type:Individual
Prefix:
First Name:DILIPKMAR
Middle Name:C
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 1:4415 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032-1337
Mailing Address - Country:US
Mailing Address - Phone:404-298-8330
Mailing Address - Fax:404-298-8361
Practice Address - Street 1:4415 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-1337
Practice Address - Country:US
Practice Address - Phone:404-298-8330
Practice Address - Fax:404-298-8361
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0291292084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
F13614Medicare UPIN
26BDBZZMedicare ID - Type Unspecified