Healthcare Provider Details

I. General information

NPI: 1710864525
Provider Name (Legal Business Name): PRIYANKA PATEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601A PROFESSIONAL DR
LAWRENCEVILLE GA
30046-3325
US

IV. Provider business mailing address

725 AGAPE PL SE
ATLANTA GA
30315-1211
US

V. Phone/Fax

Practice location:
  • Phone: 770-339-4000
  • Fax:
Mailing address:
  • Phone: 289-218-6363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number105502
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: