Healthcare Provider Details

I. General information

NPI: 1487528691
Provider Name (Legal Business Name): SANIK J PATEL PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2025
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10730 MEDLOCK BRIDGE RD
JOHNS CREEK GA
30097-2637
US

IV. Provider business mailing address

1551 JANMAR RD
SNELLVILLE GA
30078-5606
US

V. Phone/Fax

Practice location:
  • Phone: 404-948-4073
  • Fax:
Mailing address:
  • Phone: 678-344-8900
  • Fax: 678-666-5201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number13386
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: