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General NPI Number Information
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NPI Number | 1467176701
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Entity Type | Individual
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Provider Name | SRADDHA PATEL
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Gender | Female
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Dates
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Enumeration Date | 09/29/2022
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Last Update Date | 12/29/2025
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Provider Practice Location Address
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Address Line | 823 LOGANVILLE HWY
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City | BETHLEHEM
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State | GA
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Zip | 30620-1709
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Country | US
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Telephone | 470-866-2396
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Fax |
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Provider Business Mailing Address
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Address Line | 590 LANIER AVE W
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-1504
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Country | US
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Telephone | 678-688-9685
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN315487
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APRN-NP315487
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License Number State | GA
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