Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | RN241460 | GA |
NPI | 1023607140 |
---|---|
Provider Name | Dola Tejaskumar Patel |
First Address | Valdosta, GA 31602-5910 |
Second Address | Tifton, GA 31794-9497 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2021 |
Last Update Date | 22/01/2021 |