Basic Information
| Provider Information | |||||||||
| NPI: | 1962612630 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PATIL | ||||||||
| FirstName: | PRASHANT | ||||||||
| MiddleName: | V | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3495 PIEDMONT RD NE | ||||||||
| Address2: | ATTN:TOBIE | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303051717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4043650966 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3950 AUSTELL RD | ||||||||
| Address2: | BOX 22 | ||||||||
| City: | AUSTELL | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301061121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4707324022 | ||||||||
| FaxNumber: | 4707324023 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2007 | ||||||||
| LastUpdateDate: | 04/15/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | L2663 | AL | N | Allopathic & Osteopathic Physicians | Family Medicine | 207R00000X | MT190229 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | ME106548 | FL | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | 69126 | GA | Y | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.