MEDICARE: DR. RAJESH K PATEL M.D.

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	208VP0000X	Pain Medicine Physician	047130	GA
2	207LP2900X	Pain Medicine (Anesthesiology) Physician	047130	GA

General Provider Information

NPI Number	:	1366554917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAJESH K PATEL M.D.

Provider Business Mailing Address
First Line	:	3235 SATELLITE BLVD STE 104
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30096-8688
Country	:	US
Telephone Number	:	678-257-2547
Fax Number	:	770-948-6804

Provider Business Practice Location Address
First Line	:	3235 SATELLITE BLVD STE 104
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30096-8688
Country	:	US
Telephone Number	:	678-595-9631
Fax Number	:	866-317-9099

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	07/06/2020

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