Healthcare Provider Details

I. General information

NPI: 1679409445
Provider Name (Legal Business Name): NIDHI PATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 WALTON WAY
AUGUSTA GA
30904-4562
US

IV. Provider business mailing address

272 BEAVER KREEK RD
DOUGLAS GA
31533-7412
US

V. Phone/Fax

Practice location:
  • Phone: 912-381-4933
  • Fax:
Mailing address:
  • Phone: 912-381-4933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN302762
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: