Provider Demographics
NPI:1902990336
Name:PATEL, DHARMESHKUMAR CHHAGANLAL (MD)
Entity Type:Individual
Prefix:
First Name:DHARMESHKUMAR
Middle Name:CHHAGANLAL
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DHARMESH
Other - Middle Name:CHHAGANLAL
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2491 PANOLA RD
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-4831
Mailing Address - Country:US
Mailing Address - Phone:678-205-4999
Mailing Address - Fax:678-205-4969
Practice Address - Street 1:2491 PANOLA RD
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-4831
Practice Address - Country:US
Practice Address - Phone:678-205-4999
Practice Address - Fax:678-205-4969
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA055264207Q00000X
AL024168207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA959033244AMedicaid
GA959033244AMedicaid