1104817808 NPI number — DR. MANOJ K PATEL M.D.

Table of content: DR. MANOJ K PATEL M.D. (NPI 1104817808)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104817808 NPI number — DR. MANOJ K PATEL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PATEL
Provider First Name:
MANOJ
Provider Middle Name:
K
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104817808
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/20/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2424A WARM SPRINGS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31904-5638
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-327-6296
Provider Business Mailing Address Fax Number:
706-571-0036

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2424A WARM SPRINGS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31904-5638
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-327-6296
Provider Business Practice Location Address Fax Number:
706-571-0036
Provider Enumeration Date:
11/02/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X , with the licence number:  48811 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RN0300X , with the licence number: 23383 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00871582C , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00871582F , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 060010676 . This is a "BC/BS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 000055505 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00871582B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 52669915 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 699150 . This is a "BC/BS" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 00871582G , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 390006997 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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