Provider Demographics
NPI:1386069557
Name:PATEL, VIVAK
Entity type:Individual
Prefix:
First Name:VIVAK
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1475 JESSE JEWELL PKWY NE STE 300
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-3806
Mailing Address - Country:US
Mailing Address - Phone:678-430-3110
Mailing Address - Fax:678-928-5955
Practice Address - Street 1:1475 JESSE JEWELL PKWY NE STE 300
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3806
Practice Address - Country:US
Practice Address - Phone:678-430-3110
Practice Address - Fax:678-928-5955
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-25
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA86696207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease