Healthcare Provider Details

I. General information

NPI: 1265064901
Provider Name (Legal Business Name): KRISHNA V PATEL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2020
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 BOMBAY LN
ROSWELL GA
30076-5815
US

IV. Provider business mailing address

201 BOMBAY LN
ROSWELL GA
30076-5815
US

V. Phone/Fax

Practice location:
  • Phone: 770-686-3246
  • Fax: 770-674-7366
Mailing address:
  • Phone: 770-686-3246
  • Fax: 770-674-7366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number10189
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number024474
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: