Healthcare Provider Details

I. General information

NPI: 1598150880
Provider Name (Legal Business Name): RONAK PATEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2015
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1457 SCOTT BLVD
DECATUR GA
30030-1425
US

IV. Provider business mailing address

1457 SCOTT BLVD
DECATUR GA
30030-1425
US

V. Phone/Fax

Practice location:
  • Phone: 404-292-2500
  • Fax: 404-294-9361
Mailing address:
  • Phone: 404-292-2500
  • Fax: 404-294-9361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberS0770
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License Number96287
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: