Provider Demographics
NPI:1588950638
Name:PATEL, NIRAV B (MD)
Entity type:Individual
Prefix:
First Name:NIRAV
Middle Name:B
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 1:1519 JOHNSON FERRY RD STE 250
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-6494
Mailing Address - Country:US
Mailing Address - Phone:470-395-6932
Mailing Address - Fax:470-395-6951
Practice Address - Street 1:1519 JOHNSON FERRY RD STE 250
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-6494
Practice Address - Country:US
Practice Address - Phone:470-395-6932
Practice Address - Fax:470-395-6951
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-27
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA079981208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARES000Medicare UPIN