Provider Demographics
NPI:1417990987
Name:PATEL, NIPUN (MD)
Entity type:Individual
Prefix:DR
First Name:NIPUN
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3646 CHAMBLEE TUCKER RD
Mailing Address - Street 2:D
Mailing Address - City:CHAMBLEE
Mailing Address - State:GA
Mailing Address - Zip Code:30341-4406
Mailing Address - Country:US
Mailing Address - Phone:770-493-6767
Mailing Address - Fax:770-493-6797
Practice Address - Street 1:3646 CHAMBLEE TUCKER RD STE B
Practice Address - Street 2:
Practice Address - City:CHAMBLEE
Practice Address - State:GA
Practice Address - Zip Code:30341-4406
Practice Address - Country:US
Practice Address - Phone:770-493-6767
Practice Address - Fax:770-493-6797
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA46800207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000821917FMedicaid
GA000821917FMedicaid
GA11BDWTBMedicare ID - Type Unspecified