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NPI Code Detail

MEDICARE: PRIYANKA PATHAK M.D.

MEDICARE: PRIYANKA PATHAK M.D.
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
1207RH0003XHematology & Oncology Physician96110GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1417189440
Entity Type Code : Individual
Provider Name (Legal Business Name) : PRIYANKA PATHAK M.D.
Provider Business Mailing Address
First Line : 3320 OLD JEFFERSON RD BLDG 800
Second Line :
City : ATHENS
State : GA
Zip : 30607-1400
Country : US
Telephone Number : 706-353-2990
Fax Number : 706-353-2992
Provider Business Practice Location Address
First Line : 3991 HIGHWAY 78 W STE 102
Second Line :
City : SNELLVILLE
State : GA
Zip : 30039-3929
Country : US
Telephone Number : 706-353-2990
Fax Number : 706-353-2992
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2009
Last Update Date : 07/19/2024

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