Healthcare Provider Details

I. General information

NPI: 1164873261
Provider Name (Legal Business Name): ASHISH RAJENDRA PATEL M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2016
Last Update Date: 03/06/2023
Certification Date: 03/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1975 HIGHWAY 54 W STE 150
PEACHTREE CITY GA
30269-4795
US

IV. Provider business mailing address

625 19TH ST S
BIRMINGHAM AL
35233-1900
US

V. Phone/Fax

Practice location:
  • Phone: 770-486-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number83150
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: