MEDICARE: MRS. HETAL PATEL MASTERS ASSOCIATE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	001300	GA
2	101Y00000X	Counselor	LPC005135	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LPC005135	OTHER	GA	LPC

General Provider Information

NPI Number	:	1023299963
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HETAL PATEL MASTERS ASSOCIATE

Provider Business Mailing Address
First Line	:	4435 BALSAM BARK DR
Second Line	:
City	:	CUMMING
State	:	GA
Zip	:	30028-3612
Country	:	US
Telephone Number	:	229-454-0953
Fax Number	:	229-890-2289

Provider Business Practice Location Address
First Line	:	110 SAMARITAN DR. SUITE 203
Second Line	:	SUITE 203
City	:	CUMMING
State	:	GA
Zip	:	30040-3004
Country	:	US
Telephone Number	:	229-454-0953
Fax Number	:	229-346-3665

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2007
Last Update Date	:	12/07/2022

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