Healthcare Provider Details

I. General information

NPI: 1134639701
Provider Name (Legal Business Name): BHAVIKA PATEL CAA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2017
Last Update Date: 10/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 JOHNSON FY RD NE
ATLANTA GA
30342-1606
US

IV. Provider business mailing address

4401 SW 13TH ST
GAINESVILLE FL
32608-4007
US

V. Phone/Fax

Practice location:
  • Phone: 404-851-8917
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: