Healthcare Provider Details

I. General information

NPI: 1790519767
Provider Name (Legal Business Name): DILAN KALPESH PATEL PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2024
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 TURNER MCCALL BLVD NE UNIT B6-7
ROME GA
30165-2735
US

IV. Provider business mailing address

475 TURNER MCCALL BLVD NE UNIT B6-7
ROME GA
30165-2735
US

V. Phone/Fax

Practice location:
  • Phone: 706-368-8894
  • Fax: 706-368-8895
Mailing address:
  • Phone: 706-368-8894
  • Fax: 706-368-8895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number12558
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: