Healthcare Provider Details

I. General information

NPI: 1568951952
Provider Name (Legal Business Name): MEGHA PATEL DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2018
Last Update Date: 11/14/2022
Certification Date: 11/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3805 CHEROKEE ST NW
KENNESAW GA
30144-2085
US

IV. Provider business mailing address

3805 CHEROKEE ST NW
KENNESAW GA
30144-2085
US

V. Phone/Fax

Practice location:
  • Phone: 770-426-5666
  • Fax: 770-999-2075
Mailing address:
  • Phone: 770-426-5666
  • Fax: 770-999-2075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101026460
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number92041
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: