=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972179661
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BHARGAV PATEL MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/02/2021
-----------------------------------------------------
Last Update Date | 12/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 593 EDDY ST
-----------------------------------------------------
City | PROVIDENCE
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02903-4923
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-793-2695
-----------------------------------------------------
Fax | 401-444-4165
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3993 LAWRENCEVILLE HWY NW STE 140A
-----------------------------------------------------
City | LILBURN
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30047-2897
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-333-8204
-----------------------------------------------------
Fax | 404-595-1404
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 12814
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------