Healthcare Provider Details

I. General information

NPI: 1740279009
Provider Name (Legal Business Name): JAY U PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2929 LAKE PARK DR
LAKE SPIVEY GA
30236-4131
US

IV. Provider business mailing address

PO BOX 415250
BOSTON MA
02241-5250
US

V. Phone/Fax

Practice location:
  • Phone: 773-726-2682
  • Fax:
Mailing address:
  • Phone: 610-644-8900
  • Fax: 484-924-0053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number01058826
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number079216
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: