Healthcare Provider Details

I. General information

NPI: 1972179661
Provider Name (Legal Business Name): BHARGAV PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2021
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 EDDY ST
PROVIDENCE RI
02903-4923
US

IV. Provider business mailing address

3993 LAWRENCEVILLE HWY NW STE 140A
LILBURN GA
30047-2897
US

V. Phone/Fax

Practice location:
  • Phone: 401-793-2695
  • Fax: 401-444-4165
Mailing address:
  • Phone: 404-333-8204
  • Fax: 404-595-1404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number12814
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: