Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 023657 | GA |
NPI | 1003909813 |
---|---|
Provider Name | Dr. Ravi J Patel |
First Address | Vidalia, GA 30475-1870 |
Second Address | Vidalia, GA 30474 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000256209F | (05) | GA |
E58771 | (02) |