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General NPI Number Information
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NPI Number | 1477966224
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Entity Type | Individual
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Provider Name | SEJAL PATEL O.D.
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Gender | Female
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Dates
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Enumeration Date | 06/10/2014
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Last Update Date | 06/11/2024
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Provider Practice Location Address
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Address Line | 1620 PRINCE AVE
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City | ATHENS
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State | GA
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Zip | 30606-6008
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Country | US
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Telephone | 706-546-0170
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Fax | 706-546-5015
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Provider Business Mailing Address
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Address Line | 2232 TALMAI DR
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City | SNELLVILLE
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State | GA
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Zip | 30078-6202
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Country | US
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Telephone | 618-214-9145
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 046.010806
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT003286
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License Number State | GA
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