Healthcare Provider Details

I. General information

NPI: 1114471497
Provider Name (Legal Business Name): HETAL PATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2016
Last Update Date: 08/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 TOWNSEND BND
STOCKBRIDGE GA
30281-7002
US

IV. Provider business mailing address

505 TOWNSEND BND
STOCKBRIDGE GA
30281-7002
US

V. Phone/Fax

Practice location:
  • Phone: 404-914-5974
  • Fax:
Mailing address:
  • Phone: 404-914-5974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH020524
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: