Healthcare Provider Details

I. General information

NPI: 1346908746
Provider Name (Legal Business Name): RUTA DHARMESH PANCHAL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2021
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 CAMPBELL HILL ST NW STE 250
MARIETTA GA
30060-1162
US

IV. Provider business mailing address

677 CHURCH ST. GREEN TOWER, LOWER LEVEL
MARIETTA GA
30060
US

V. Phone/Fax

Practice location:
  • Phone: 470-956-2020
  • Fax: 770-999-2785
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: