Healthcare Provider Details

I. General information

NPI: 1326055609
Provider Name (Legal Business Name): PRAVINCHANDRA H PATEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 TALBOTTON RD
COLUMBUS GA
31904-8749
US

IV. Provider business mailing address

1041 TALBOTTON RD
COLUMBUS GA
31904-8745
US

V. Phone/Fax

Practice location:
  • Phone: 706-327-0700
  • Fax: 706-327-0757
Mailing address:
  • Phone: 706-327-0700
  • Fax: 706-327-0757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number027888
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: