Provider Demographics
NPI:1962985028
Name:PATEL, NIKITA HARISH (ARNP)
Entity type:Individual
Prefix:
First Name:NIKITA
Middle Name:HARISH
Last Name:PATEL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1365 ROCK QUARRY RD STE 202
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-5023
Mailing Address - Country:US
Mailing Address - Phone:770-771-6580
Mailing Address - Fax:
Practice Address - Street 1:1365 ROCK QUARRY RD STE 202
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-5023
Practice Address - Country:US
Practice Address - Phone:770-771-6580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-13
Last Update Date:2018-11-14
Deactivation Date:2018-09-25
Deactivation Code:
Reactivation Date:2018-11-14
Provider Licenses
StateLicense IDTaxonomies
GA251452363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1174909287Medicaid