Provider Demographics
NPI:1649552134
Name:PATEL, INDIRA ASHOK (LICENSED PHYSICAL TH)
Entity type:Individual
Prefix:MRS
First Name:INDIRA
Middle Name:ASHOK
Last Name:PATEL
Suffix:
Gender:F
Credentials:LICENSED PHYSICAL TH
Other - Prefix:MRS
Other - First Name:INDIRA
Other - Middle Name:ASHOKICUMAR
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICENSED PHYSICAL TH
Mailing Address - Street 1:2839 HIDDEN FALLS DRIVE
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519
Mailing Address - Country:US
Mailing Address - Phone:770-904-5903
Mailing Address - Fax:
Practice Address - Street 1:2839 HIDDEN FALLS DRIVE
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519
Practice Address - Country:US
Practice Address - Phone:770-904-5903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-12
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT002755208100000X
IL00700003106208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation