Healthcare Provider Details

I. General information

NPI: 1992798623
Provider Name (Legal Business Name): HARSHAD AMBALAL PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: HARSHAD PATEL MD

II. Dates (important events)

Enumeration Date: 08/29/2005
Last Update Date: 03/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4994 LOWER ROSWELL RD SUITE 29
MARIETTA GA
30068-4332
US

IV. Provider business mailing address

4994 LOWER ROSWELL RD SUITE 29
MARIETTA GA
30068-4332
US

V. Phone/Fax

Practice location:
  • Phone: 770-977-2987
  • Fax: 678-236-6041
Mailing address:
  • Phone: 770-977-2987
  • Fax: 678-236-6041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number046799
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: