Healthcare Provider Details

I. General information

NPI: 1245812569
Provider Name (Legal Business Name): ISHANI KIRANKUMAR PATEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2021
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 REGENCY PARK DR STE 110
MCDONOUGH GA
30253-7076
US

IV. Provider business mailing address

101 REGENCY PARK DR STE 110
MCDONOUGH GA
30253-7076
US

V. Phone/Fax

Practice location:
  • Phone: 404-996-0126
  • Fax: 678-432-2626
Mailing address:
  • Phone: 404-996-0126
  • Fax: 678-432-2626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA12781400
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number112627
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: