Basic Information
| Provider Information | |||||||||
| NPI: | 1245762822 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | PAYAL | ||||||||
| MiddleName: | SHAILESH | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 615 MICHAEL ST NE STE 205 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303221047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047128286 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1364 CLIFTON RD NE | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303227232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047128286 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2017 | ||||||||
| LastUpdateDate: | 09/30/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 125071385 | IL | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 01083110A | IN | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207RC0200X | 85763 | GA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207P00000X | 85763 | GA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.