Healthcare Provider Details

I. General information

NPI: 1053852384
Provider Name (Legal Business Name): KRISHNA PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2017
Last Update Date: 08/08/2023
Certification Date: 08/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1968 PEACHTREE RD NW
ATLANTA GA
30309-1281
US

IV. Provider business mailing address

PO BOX 2326
INDIANAPOLIS IN
46206-2326
US

V. Phone/Fax

Practice location:
  • Phone: 877-263-8651
  • Fax:
Mailing address:
  • Phone: 877-263-8651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number92316
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number92316
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: