Healthcare Provider Details

I. General information

NPI: 1609912328
Provider Name (Legal Business Name): NARENDRA M PATEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 09/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 W WAUGH ST
DALTON GA
30720-8769
US

IV. Provider business mailing address

1102 W WAUGH ST
DALTON GA
30720-8769
US

V. Phone/Fax

Practice location:
  • Phone: 706-529-9090
  • Fax:
Mailing address:
  • Phone: 706-529-9090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number031092
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: