Healthcare Provider Details

I. General information

NPI: 1417883174
Provider Name (Legal Business Name): NIKETU PRAFUL PATEL O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 PEACHTREE ST NE STE 1500
ATLANTA GA
30308-2248
US

IV. Provider business mailing address

344 WILKERSON WAY
GRAYSON GA
30017-3204
US

V. Phone/Fax

Practice location:
  • Phone: 404-897-6810
  • Fax:
Mailing address:
  • Phone: 404-918-3018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT003744
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: