Healthcare Provider Details

I. General information

NPI: 1730743915
Provider Name (Legal Business Name): RUTVI PATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2019
Last Update Date: 08/16/2024
Certification Date: 08/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 MANCHESTER EXPY STE C001
COLUMBUS GA
31904-6877
US

IV. Provider business mailing address

2300 MANCHESTER EXPY STE 2001A
COLUMBUS GA
31904-6802
US

V. Phone/Fax

Practice location:
  • Phone: 706-324-3243
  • Fax: 706-324-3835
Mailing address:
  • Phone: 706-320-3126
  • Fax: 706-320-3054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number101182
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: