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General NPI Number Information
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NPI Number | 1003088576
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Entity Type | Individual
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Provider Name | JIGISHA K PATEL DENTIST
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Gender | Female
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Dates
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Enumeration Date | 03/25/2008
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Last Update Date | 03/25/2008
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Provider Practice Location Address
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Address Line | 6128 PRESTLEY MILL RD SUITE-E
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City | DOUGLASVILLE
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State | GA
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Zip | 30134-5621
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Country | US
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Telephone | 770-949-0434
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Fax | 770-949-0886
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Provider Business Mailing Address
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Address Line | 6128 PRESTLEY MILL RD SUITE-E
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City | DOUGLASVILLE
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State | GA
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Zip | 30134-5621
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Country | US
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Telephone | 770-949-0434
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Fax | 770-949-0886
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | GA-011358
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License Number State | GA
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