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General NPI Number Information
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NPI Number | 1447254131
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Entity Type | Individual
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Provider Name | KETAN B PATEL DPM
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Gender | Male
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Dates
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Enumeration Date | 06/09/2005
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Last Update Date | 12/09/2015
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Provider Practice Location Address
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Address Line | 1720 HONEY CREEK COMMONS STE B
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City | CONYERS
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State | GA
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Zip | 30013-5826
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Country | US
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Telephone | 770-483-1100
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Fax | 770-483-5855
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Provider Business Mailing Address
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Address Line | 1975 HIGHWAY 54 W SUITE 205
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-4794
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Country | US
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Telephone | 678-561-9000
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Fax | 770-487-1232
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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 | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 000928
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License Number State | GA
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