Provider Demographics
NPI:1962612630
Name:PATIL, PRASHANT V (MD)
Entity type:Individual
Prefix:DR
First Name:PRASHANT
Middle Name:V
Last Name:PATIL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3495 PIEDMONT RD NE
Mailing Address - Street 2:ATTN:TOBIE
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-1717
Mailing Address - Country:US
Mailing Address - Phone:404-365-0966
Mailing Address - Fax:
Practice Address - Street 1:3950 AUSTELL RD
Practice Address - Street 2:BOX 22
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-1121
Practice Address - Country:US
Practice Address - Phone:470-732-4022
Practice Address - Fax:470-732-4023
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2019-04-15
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Provider Licenses
StateLicense IDTaxonomies
ALL2663207Q00000X
PAMT190229207R00000X
FLME106548208M00000X
GA69126208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine