Healthcare Provider Details

I. General information

NPI: 1003685025
Provider Name (Legal Business Name): SHIVANI PATEL CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2024
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 FRANKLIN GTWY SE
MARIETTA GA
30067-8705
US

IV. Provider business mailing address

1405 FRANKLIN GTWY SE
MARIETTA GA
30067-8705
US

V. Phone/Fax

Practice location:
  • Phone: 770-951-5400
  • Fax: 770-702-1312
Mailing address:
  • Phone: 770-951-5400
  • Fax: 770-702-1312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN300775
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number202325129
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: