Healthcare Provider Details

I. General information

NPI: 1184672008
Provider Name (Legal Business Name): PIYUSH C PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 08/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2340 PATRICK HENRY PKWY STE 225
MCDONOUGH GA
30253-4214
US

IV. Provider business mailing address

2340 PATRICK HENRY PKWY STE 225
MCDONOUGH GA
30253-4214
US

V. Phone/Fax

Practice location:
  • Phone: 770-389-8100
  • Fax: 770-389-3030
Mailing address:
  • Phone: 770-389-8100
  • Fax: 770-389-3030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number053357
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: