Healthcare Provider Details

I. General information

NPI: 1336469485
Provider Name (Legal Business Name): KEVAL A PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2010
Last Update Date: 01/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7402 DAVIDSON PKWY S
STOCKBRIDGE GA
30281
US

IV. Provider business mailing address

7402 DAVIDSON PKWY S
STOCKBRIDGE GA
30281
US

V. Phone/Fax

Practice location:
  • Phone: 770-507-0909
  • Fax: 770-507-1919
Mailing address:
  • Phone: 770-507-0909
  • Fax: 770-507-1919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number075863
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number50014
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: