Healthcare Provider Details

I. General information

NPI: 1073192324
Provider Name (Legal Business Name): NISHA BHUPESH PATEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2021
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 EXECUTIVE PARK S STE 400
ATLANTA GA
30329-2249
US

IV. Provider business mailing address

57 EXECUTIVE PARK S STE 400
ATLANTA GA
30329-2249
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-3261
  • Fax:
Mailing address:
  • Phone: 404-778-3261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number2025012240
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number113216
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number113216
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: