Provider Demographics
NPI:1912167131
Name:PATEL, BANSARI GAUTAM (MD)
Entity type:Individual
Prefix:
First Name:BANSARI
Middle Name:GAUTAM
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 1:5909 PEACHTREE DUNWOODY RD STE 600
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-8101
Mailing Address - Country:US
Mailing Address - Phone:770-928-2276
Mailing Address - Fax:770-592-2092
Practice Address - Street 1:5909 PEACHTREE DUNWOODY RD STE 600
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-8101
Practice Address - Country:US
Practice Address - Phone:770-928-2276
Practice Address - Fax:770-592-2092
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-11
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA80437207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology