Healthcare Provider Details

I. General information

NPI: 1225598816
Provider Name (Legal Business Name): SAGAR PRAVIN PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2019
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MOSAIC CIR STE 340
POOLER GA
31322-1611
US

IV. Provider business mailing address

500 MOSAIC CIR STE 340
POOLER GA
31322-1611
US

V. Phone/Fax

Practice location:
  • Phone: 912-350-6000
  • Fax: 912-748-8933
Mailing address:
  • Phone: 912-350-6000
  • Fax: 912-748-8933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number90096
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: