Healthcare Provider Details

I. General information

NPI: 1093334302
Provider Name (Legal Business Name): NIKITA PATIL DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2020
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 JOHNSON FY RD NE
SANDY SPRINGS GA
30342-1605
US

IV. Provider business mailing address

1001 JOHNSON FY RD NE
SANDY SPRINGS GA
30342-1605
US

V. Phone/Fax

Practice location:
  • Phone: 404-907-4242
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number111055
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberE-16650
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: