Healthcare Provider Details

I. General information

NPI: 1164884763
Provider Name (Legal Business Name): GINA PATEL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2016
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2970 BRANDYWINE RD STE 125
ATLANTA GA
30341-5528
US

IV. Provider business mailing address

2970 BRANDYWINE RD STE 125
ATLANTA GA
30341-5528
US

V. Phone/Fax

Practice location:
  • Phone: 404-256-2593
  • Fax: 770-488-9408
Mailing address:
  • Phone: 678-764-8010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number99489
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number99489
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: