Provider Demographics
NPI:1982284618
Name:PATEL, DHARA (MD)
Entity Type:Individual
Prefix:
First Name:DHARA
Middle Name:
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 1:200 EAGLES NEST DR BLDG 300D
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30115-2028
Mailing Address - Country:US
Mailing Address - Phone:678-455-3200
Mailing Address - Fax:770-888-9998
Practice Address - Street 1:200 EAGLES NEST DR BLDG 300D
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30115-2028
Practice Address - Country:US
Practice Address - Phone:678-455-3200
Practice Address - Fax:770-888-9998
Is Sole Proprietor?:No
Enumeration Date:2021-04-08
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA98411207Q00000X
390200000X
PAMT222920207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program