Healthcare Provider Details

I. General information

NPI: 1124190079
Provider Name (Legal Business Name): PREETESH P. PATEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 05/03/2021
Certification Date: 05/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1295 HEMBREE ROAD STE 101
ROSWELL GA
30076-3809
US

IV. Provider business mailing address

P.O. BOX 629
AUSTELL GA
30168-1006
US

V. Phone/Fax

Practice location:
  • Phone: 770-948-6824
  • Fax: 770-948-6804
Mailing address:
  • Phone: 770-948-6824
  • Fax: 770-948-6804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA94696
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number054631
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number054631
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number54631
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: