Healthcare Provider Details

I. General information

NPI: 1689584039
Provider Name (Legal Business Name): VIRAL PATEL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4229 MANER ST SE
SMYRNA GA
30080
US

IV. Provider business mailing address

1820 STEPHANIE TRL NE
ATLANTA GA
30329-3578
US

V. Phone/Fax

Practice location:
  • Phone: 404-574-8169
  • Fax:
Mailing address:
  • Phone: 404-574-8169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberRPH029305
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: