MEDICARE: DIPAK B 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	207Q00000X	Family Medicine Physician	048174	GA

General Provider Information

NPI Number	:	1407849524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIPAK B PATEL M.D.

Provider Business Mailing Address
First Line	:	4700 NELSON BROGDON BLVD
Second Line	:	STE 180
City	:	SUGARHILL
State	:	GA
Zip	:	30518-5400
Country	:	US
Telephone Number	:	770-945-7676
Fax Number	:	770-932-9845

Provider Business Practice Location Address
First Line	:	4700 NELSON BROGDON BLVD
Second Line	:	STE 180
City	:	SUGARHILL
State	:	GA
Zip	:	30518-5400
Country	:	US
Telephone Number	:	770-945-7676
Fax Number	:	770-932-9845

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

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	02/12/2024

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