Provider Demographics
NPI:1942979737
Name:PATEL, MAULIKABEN (FNP-C)
Entity type:Individual
Prefix:
First Name:MAULIKABEN
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 WHITE INGRAM PKWY STE 500
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30132-0972
Mailing Address - Country:US
Mailing Address - Phone:770-615-0951
Mailing Address - Fax:
Practice Address - Street 1:311 WHITE INGRAM PKWY STE 500
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30132-0972
Practice Address - Country:US
Practice Address - Phone:770-615-0951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-07
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN274301363LF0000X, 207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty