Provider Demographics
NPI:1750910865
Name:PATEL, KISHAN AJIT (MD)
Entity type:Individual
Prefix:MR
First Name:KISHAN
Middle Name:AJIT
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3400 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-2513
Mailing Address - Country:US
Mailing Address - Phone:478-474-5600
Mailing Address - Fax:478-471-6769
Practice Address - Street 1:3400 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-2513
Practice Address - Country:US
Practice Address - Phone:478-474-5600
Practice Address - Fax:478-471-6769
Is Sole Proprietor?:No
Enumeration Date:2020-04-02
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA95079207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine