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General NPI Number Information
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NPI Number | 1205866878
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Entity Type | Individual
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Provider Name | HARRIS A PATEL PA-C, ATC
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Gender | Male
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Dates
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Enumeration Date | 07/03/2006
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Last Update Date | 04/14/2009
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Provider Practice Location Address
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Address Line | 1900 RIVERSIDE PKWY
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-5925
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Country | US
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Telephone | 678-471-7909
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Fax |
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Provider Business Mailing Address
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Address Line | 1935 RACQUET CLUB CIR
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-5651
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Country | US
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Telephone | 678-471-7909
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT000821
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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