Healthcare Provider Details

I. General information

NPI: 1831416270
Provider Name (Legal Business Name): NIDHIP ANIL PATEL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2010
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MEDICAL CENTER BLVD STE 310
LAWRENCEVILLE GA
30046-3332
US

IV. Provider business mailing address

PO BOX 116360
ATLANTA GA
30368-6360
US

V. Phone/Fax

Practice location:
  • Phone: 678-312-0500
  • Fax: 678-312-0525
Mailing address:
  • Phone: 678-312-5600
  • Fax: 678-312-0439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOS12132
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS12132
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number73620
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: