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General NPI Number Information
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NPI Number | 1407634801
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Entity Type | Individual
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Provider Name | PUJA PATEL PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/18/2023
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Last Update Date | 09/18/2023
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Provider Practice Location Address
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Address Line | 4505 ASHFORD DUNWOODY RD NE STE 15B
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City | DUNWOODY
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State | GA
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Zip | 30346-1516
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Country | US
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Telephone | 337-692-4016
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Fax |
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Provider Business Mailing Address
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Address Line | 2825 WINDY HILL RD SE UNIT 1-09101
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City | MARIETTA
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State | GA
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Zip | 30067-6106
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Country | US
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Telephone | 337-692-4016
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 11624
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License Number State | GA
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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 | 11624
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License Number State | GA
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