Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 0024271 | TX |
N | 1223X0400X | Orthodontists | DN013835 | GA |
NPI | 1063655827 |
---|---|
Provider Name | Dr. Tina Patel |
First Address | Atlanta, GA 30305-5709 |
Second Address | Decatur, GA 30030-3466 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2009 |
Last Update Date | 28/10/2010 |