Provider Demographics
NPI:1871788935
Name:PATEL, DHARTI (NP)
Entity type:Individual
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First Name:DHARTI
Middle Name:
Last Name:PATEL
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Gender:F
Credentials:NP
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Mailing Address - Street 1:55 WHITCHER ST NE
Mailing Address - Street 2:SUITE 350
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1155
Mailing Address - Country:US
Mailing Address - Phone:770-424-6893
Mailing Address - Fax:770-424-9095
Practice Address - Street 1:55 WHITCHER ST NE
Practice Address - Street 2:SUITE 350
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1155
Practice Address - Country:US
Practice Address - Phone:770-424-6893
Practice Address - Fax:770-424-9095
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2012-06-11
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Provider Licenses
StateLicense IDTaxonomies
IL209-006178363LA2200X
GARN149650364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003106975AMedicaid
GA003106975BMedicaid
GA003106975C-Medicaid
GA003106975C-Medicaid