Healthcare Provider Details

I. General information

NPI: 1710449400
Provider Name (Legal Business Name): AMISHA PATEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2019
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5150 STILESBORO RD NW
KENNESAW GA
30152-7744
US

IV. Provider business mailing address

707 BOXWOOD MANOR CT
MANCHESTER MO
63021-7185
US

V. Phone/Fax

Practice location:
  • Phone: 770-424-8222
  • Fax:
Mailing address:
  • Phone: 636-208-3570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2022033353
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number98275
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: