Provider Demographics
NPI:1992798623
Name:PATEL, HARSHAD AMBALAL (MD)
Entity type:Individual
Prefix:
First Name:HARSHAD
Middle Name:AMBALAL
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:HARSHAD
Other - Middle Name:
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4994 LOWER ROSWELL RD
Mailing Address - Street 2:SUITE 29
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-4332
Mailing Address - Country:US
Mailing Address - Phone:770-977-2987
Mailing Address - Fax:678-236-6041
Practice Address - Street 1:4994 LOWER ROSWELL RD
Practice Address - Street 2:SUITE 29
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-4332
Practice Address - Country:US
Practice Address - Phone:770-977-2987
Practice Address - Fax:678-236-6041
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-29
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0467992084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000820146AMedicaid
GA000820146DMedicaid
GA26BDGTTMedicare ID - Type Unspecified
GA000820146AMedicaid