Healthcare Provider Details

I. General information

NPI: 1578590170
Provider Name (Legal Business Name): SHILA B PATEL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2704 N OAK ST BUILDING B-3
VALDOSTA GA
31602-1744
US

IV. Provider business mailing address

773 LAKE LAURIE DR
VALDOSTA GA
31605-6421
US

V. Phone/Fax

Practice location:
  • Phone: 229-257-0100
  • Fax: 229-257-0050
Mailing address:
  • Phone: 229-257-0100
  • Fax: 229-257-0050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number026801
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: