Healthcare Provider Details

I. General information

NPI: 1770511156
Provider Name (Legal Business Name): NITIN RASIKCHANDRA PATEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 04/22/2021
Certification Date: 04/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2109 N PATTERSON ST STE B
VALDOSTA GA
31602-2577
US

IV. Provider business mailing address

2109 N PATTERSON ST STE B
VALDOSTA GA
31602-2577
US

V. Phone/Fax

Practice location:
  • Phone: 229-232-4833
  • Fax: 877-343-0538
Mailing address:
  • Phone: 229-232-4833
  • Fax: 877-343-0538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number037324
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number37324
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number37324
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number37324
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: