Healthcare Provider Details

I. General information

NPI: 1104763242
Provider Name (Legal Business Name): RIDDHI PIYUSH PATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 JOHNSON FERRY RD
SANDY SPRINGS GA
30342-1709
US

IV. Provider business mailing address

3061 PRINCETON HILL DR NW
CLEVELAND TN
37312-1773
US

V. Phone/Fax

Practice location:
  • Phone: 404-953-4034
  • Fax:
Mailing address:
  • Phone: 423-310-2664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT003764
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: