MEDICARE: NIRALI ASHESH PATEL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	105603	GA

General Provider Information

NPI Number	:	1255081535
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIRALI ASHESH PATEL MD

Provider Business Mailing Address
First Line	:	5300 BOWMAN ROAD
Second Line	:
City	:	MACON
State	:	GA
Zip	:	31210-7527
Country	:	US
Telephone Number	:	478-550-3108
Fax Number	:

Provider Business Practice Location Address
First Line	:	5300 BOWMAN ROAD
Second Line	:
City	:	MACON
State	:	GA
Zip	:	31210
Country	:	US
Telephone Number	:	478-741-3007
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2022
Last Update Date	:	01/15/2026

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