Healthcare Provider Details

I. General information

NPI: 1083758635
Provider Name (Legal Business Name): ASHISH B PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 05/25/2022
Certification Date: 05/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2675 N DECATUR RD STE G09
DECATUR GA
30033-6130
US

IV. Provider business mailing address

1400 PIEDMONT AVE NE UNIT 5
ATLANTA GA
30309-3307
US

V. Phone/Fax

Practice location:
  • Phone: 404-501-6925
  • Fax: 404-501-6930
Mailing address:
  • Phone: 609-721-1130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number84253
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: