Provider Demographics
NPI:1447254131
Name:PATEL, KETAN B (DPM)
Entity type:Individual
Prefix:DR
First Name:KETAN
Middle Name:B
Last Name:PATEL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1975 HIGHWAY 54 W
Mailing Address - Street 2:SUITE 205
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-4794
Mailing Address - Country:US
Mailing Address - Phone:678-561-9000
Mailing Address - Fax:770-487-1232
Practice Address - Street 1:1720 HONEY CREEK COMMONS
Practice Address - Street 2:STE B
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-5826
Practice Address - Country:US
Practice Address - Phone:770-483-1100
Practice Address - Fax:770-483-5855
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA000928213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00915725AMedicaid
48SCCGZMedicare ID - Type Unspecified
U86029Medicare UPIN