=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043221583
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HAMANT B. PATEL, MD, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/10/2006
-----------------------------------------------------
Last Update Date | 08/21/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1558 WATSON BLVD
-----------------------------------------------------
City | WARNER ROBINS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31093-3432
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 478-918-0120
-----------------------------------------------------
Fax | 478-329-1900
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1558 WATSON BLVD
-----------------------------------------------------
City | WARNER ROBINS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31093-3432
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 478-918-0120
-----------------------------------------------------
Fax | 478-329-1900
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | HAMANT B. PATEL
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 478-918-0120
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | 043738
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------