Healthcare Provider Details

I. General information

NPI: 1205625902
Provider Name (Legal Business Name): RUTVI DEEPAK PATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2025
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 NEWNAN CROSSING BYP
NEWNAN GA
30265-1063
US

IV. Provider business mailing address

2208 LOCKSLEY LN
WOODRUFF SC
29388-6801
US

V. Phone/Fax

Practice location:
  • Phone: 678-621-6410
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN123825
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: