Provider Demographics
NPI:1942527478
Name:ARAVINDAKSHAN PATEL, NISHA PANICKER (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:NISHA
Middle Name:PANICKER
Last Name:ARAVINDAKSHAN PATEL
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:NISHA
Other - Middle Name:P
Other - Last Name:ARAVINDAKSHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:543 WINTON TER NE UNIT A
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-2826
Mailing Address - Country:US
Mailing Address - Phone:151-642-4079
Mailing Address - Fax:
Practice Address - Street 1:1514 VERNON RD
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-4131
Practice Address - Country:US
Practice Address - Phone:706-812-2369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-23
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA207172207R00000X, 207RI0200X, 208000000X
WI67339-20207R00000X, 208000000X, 207RI0200X
GA75597207R00000X, 207RI0200X, 208000000X, 208M00000X
FLME132196207R00000X, 208000000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGA2058Medicaid
GA202I210707Medicaid
LA2361368Medicaid