Healthcare Provider Details

I. General information

NPI: 1598112575
Provider Name (Legal Business Name): JEEVITHA PATIL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2016
Last Update Date: 12/15/2020
Certification Date: 12/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11975 MORRIS RD STE 200
ALPHARETTA GA
30005-4444
US

IV. Provider business mailing address

5780 PEACHTREE DUNWOODY RD STE 300
ATLANTA GA
30342-1513
US

V. Phone/Fax

Practice location:
  • Phone: 404-303-1224
  • Fax: 404-303-1325
Mailing address:
  • Phone: 404-303-8035
  • Fax: 404-303-1325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number86422
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: