Healthcare Provider Details

I. General information

NPI: 1780971994
Provider Name (Legal Business Name): ANKUR BHARAT PATEL D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2011
Last Update Date: 05/25/2022
Certification Date: 05/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 BROAD ST SE STE B
GAINESVILLE GA
30501-3718
US

IV. Provider business mailing address

PO BOX 28415
BELFAST ME
04915-2036
US

V. Phone/Fax

Practice location:
  • Phone: 678-971-4167
  • Fax: 833-989-2501
Mailing address:
  • Phone: 888-488-8289
  • Fax: 502-919-9780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number2017043613
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberDO 1611
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number84015
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: