Basic Information
| Provider Information | |||||||||
| NPI: | 1003012949 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PATEL-RAVAL | ||||||||
| FirstName: | PINECCA | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5555 PEACHTREE DUNWOODY RD NE | ||||||||
| Address2: | STE 215 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303421703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704554009 | ||||||||
| FaxNumber: | 7704554065 | ||||||||
| Practice Location | |||||||||
| Address1: | 5830 BOND ST | ||||||||
| Address2: | STE 200 | ||||||||
| City: | CUMMING | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300400307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704554009 | ||||||||
| FaxNumber: | 7704554065 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2007 | ||||||||
| LastUpdateDate: | 11/19/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | POD001059 | GA | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
ID Information
| ID | Type | State | Issuer | Description | 2320170 | 01 | GA | CIGNA | OTHER |