Healthcare Provider Details

I. General information

NPI: 1275317877
Provider Name (Legal Business Name): BINITABEN A PATEL RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2023
Last Update Date: 08/23/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1341 CANTON RD STE B
MARIETTA GA
30066-6056
US

IV. Provider business mailing address

2146 ROSWELL RD STE 108
MARIETTA GA
30062-3815
US

V. Phone/Fax

Practice location:
  • Phone: 404-934-0076
  • Fax:
Mailing address:
  • Phone: 404-934-0076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License NumberLD001815
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: