Healthcare Provider Details

I. General information

NPI: 1225045057
Provider Name (Legal Business Name): BIPINCHANDRA RAOJIBHAI PATEL M.D., FACS, FACRS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 03/07/2023
Certification Date: 04/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11459 JOHNS CREEK PKWY STE 240
JOHNS CREEK GA
30097-3517
US

IV. Provider business mailing address

11459 JOHNS CREEK PKWY STE 240
JOHNS CREEK GA
30097-3517
US

V. Phone/Fax

Practice location:
  • Phone: 470-395-6932
  • Fax: 470-395-6951
Mailing address:
  • Phone: 470-395-6932
  • Fax: 470-395-6951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number137389
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberNY137389
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: