Provider Demographics
NPI:1881739969
Name:PATEL, SONAL MAGAN (OD)
Entity type:Individual
Prefix:DR
First Name:SONAL
Middle Name:MAGAN
Last Name:PATEL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1173 NORTHLAKE MALL
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345
Mailing Address - Country:US
Mailing Address - Phone:770-493-9171
Mailing Address - Fax:
Practice Address - Street 1:1173 NORTHLAKE MALL
Practice Address - Street 2:4800 BRIARCLIFF RD. NE
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345
Practice Address - Country:US
Practice Address - Phone:770-493-9171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT 2031152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist