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General NPI Number Information
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NPI Number | 1750455051
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Entity Type | Individual
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Provider Name | ATUSHA PATEL
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Gender | Female
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3050 FIVE FORKS TRICKUM RD SW #H
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City | LILBURN
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State | GA
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Zip | 30047-1807
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Country | US
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Telephone | 770-982-7533
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Fax |
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Provider Business Mailing Address
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Address Line | 2502 N ROCKY POINT DR STE 1000 8TH FLOOR
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City | TAMPA
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State | FL
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Zip | 33607-1449
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Country | US
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Telephone |
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN011566
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License Number State | GA
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