Healthcare Provider Details

I. General information

NPI: 1205170537
Provider Name (Legal Business Name): MANISHA PATEL MD, MSC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2012
Last Update Date: 11/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 PEACHTREE ST NE TRAVELWELL 7TH FLOOR, MEDICAL OFFICE TOWER
ATLANTA GA
30308-2208
US

IV. Provider business mailing address

1600 CLIFTON RD NE MS C25
ATLANTA GA
30329-4018
US

V. Phone/Fax

Practice location:
  • Phone: 404-686-5885
  • Fax:
Mailing address:
  • Phone: 404-639-2422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number64949
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: