Healthcare Provider Details

I. General information

NPI: 1457292807
Provider Name (Legal Business Name): MITT DINESH PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 HEMLOCK ST
MACON GA
31201-2102
US

IV. Provider business mailing address

777 HEMLOCK ST MSC 69
MACON GA
31201-2102
US

V. Phone/Fax

Practice location:
  • Phone: 478-633-1000
  • Fax:
Mailing address:
  • Phone: 478-633-7685
  • Fax: 478-633-5127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number113284
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: