Healthcare Provider Details

I. General information

NPI: 1033557806
Provider Name (Legal Business Name): JAVED FIROZ PATKA D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2013
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2260 VISTA RD
FORT MILL SC
29708-7800
US

IV. Provider business mailing address

1750 HIGHWAY 160 W STE 101-239
FORT MILL SC
29708-8009
US

V. Phone/Fax

Practice location:
  • Phone: 839-400-2400
  • Fax:
Mailing address:
  • Phone: 706-294-9785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS12967
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDO83010
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2020-00183
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: