Healthcare Provider Details

I. General information

NPI: 1639556657
Provider Name (Legal Business Name): VIMAL KIRIT PATEL D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2015
Last Update Date: 02/15/2021
Certification Date: 02/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1266 HIGHWAY 515 S
JASPER GA
30143-4872
US

IV. Provider business mailing address

7800 US HIGHWAY 98 W
MIRAMAR BEACH FL
32550-7228
US

V. Phone/Fax

Practice location:
  • Phone: 404-367-3014
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number85423
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS14819
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: