Healthcare Provider Details

I. General information

NPI: 1043128028
Provider Name (Legal Business Name): AMERICAN MEDICAL GEORGIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 E 3RD AVE
CORDELE GA
31015-3605
US

IV. Provider business mailing address

197 BASS RD
MACON GA
31210-2060
US

V. Phone/Fax

Practice location:
  • Phone: 478-477-0966
  • Fax:
Mailing address:
  • Phone: 478-477-0966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JAYESH PATEL
Title or Position: OWNER
Credential: MD
Phone: 478-365-2164