Healthcare Provider Details

I. General information

NPI: 1942979737
Provider Name (Legal Business Name): MAULIKABEN PATEL FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2021
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 WHITE INGRAM PKWY STE 500
DALLAS GA
30132-0972
US

IV. Provider business mailing address

311 WHITE INGRAM PKWY STE 500
DALLAS GA
30132-0972
US

V. Phone/Fax

Practice location:
  • Phone: 770-615-0951
  • Fax:
Mailing address:
  • Phone: 770-615-0951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP274301
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberAPRN-NP274301
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: