MEDICARE: MR. DARSHAN ASHOKKUMAR PATEL

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	2084P0804X	Child & Adolescent Psychiatry Physician	072070	GA

General Provider Information

NPI Number	:	1295977809
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DARSHAN ASHOKKUMAR PATEL

Provider Business Mailing Address
First Line	:	1445 ROCA QUARRY RD
Second Line	:	SUITE 108
City	:	STOCKBRIDGE
State	:	GA
Zip	:	30281
Country	:	US
Telephone Number	:	770-402-6849
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 EAGLES LANDING PKWY
Second Line	:
City	:	STOCKBRIDGE
State	:	GA
Zip	:	30281-5012
Country	:	US
Telephone Number	:	770-402-6849
Fax Number	:

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

Provider Enumeration Date	:	03/27/2009
Last Update Date	:	11/06/2015

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