Healthcare Provider Details

I. General information

NPI: 1437727518
Provider Name (Legal Business Name): NIKITA PATEL PAA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2021
Last Update Date: 06/15/2021
Certification Date: 06/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 JOHNSON FY RD NE
ATLANTA GA
30342-1600
US

IV. Provider business mailing address

1103 PEACHFORD CIR
DUNWOODY GA
30338-6477
US

V. Phone/Fax

Practice location:
  • Phone: 404-785-2008
  • Fax:
Mailing address:
  • Phone: 407-446-7110
  • 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: