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General NPI Number Information
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NPI Number | 1083215214
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Entity Type | Individual
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Provider Name | PRITAL PATEL PA-C
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Gender | Female
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Dates
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Enumeration Date | 11/04/2020
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Last Update Date | 10/07/2024
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Provider Practice Location Address
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Address Line | 1825 HIGHWAY 34 E STE 1200
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City | NEWNAN
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State | GA
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Zip | 30265-6416
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Country | US
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Telephone | 770-502-2112
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Fax | 770-502-2113
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Provider Business Mailing Address
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Address Line | 113 FOUNTAIN OAK
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City | VILLA RICA
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State | GA
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Zip | 30180-6994
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Country | US
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Telephone |
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Fax |
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 10075
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License Number State | GA
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