Healthcare Provider Details

I. General information

NPI: 1447937339
Provider Name (Legal Business Name): RACHNA PATEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2023
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 AVERA DR
FORT VALLEY GA
31030-5008
US

IV. Provider business mailing address

201 AVERA DR
FORT VALLEY GA
31030-5008
US

V. Phone/Fax

Practice location:
  • Phone: 478-654-2300
  • Fax:
Mailing address:
  • Phone: 478-654-2300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number111819
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: