CHAMPAK PATEL (NPI# 1073585782) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073585782 |
| Entity Type | Individual |
| Full Name | CHAMPAK PATEL |
| Credential | MD |
| Practice Address |
5196 Hwy 53 Braselton GA 30517 |
| Mailing Address |
455 Beaver Ruin Rd Lilburn GA 30047 |
| Practice Telephone | 7068249929 |
| Practice Fax Number | 7066549373 |
| Mailing Telephone | 7709237778 |
| Mailing Fax Number | 7708061383 |
| Enumeration Date | 2006-02-06 |
| Last Update Date | 2008-06-12 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 173000000X | Legal Medicine | 059888 | GA | Other Service Providers |
| N | 207RP1001X |
Internal Medicine Specialization: Pulmonary Disease |
123503 | NY | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | 00525411 | 05 | |
| NY | TAX ID | 141618275 | 01 |
| NY | EMPIRE | 349351 | 01 |
| NY | GHI | 75786IM | 01 |
| NY | MVP | 11136 | 01 |
| GA | 554972145A | 05 | |
| NY | BLUE SHIELD | 000411428001 | 01 |
| Street Address |
5196 HWY 53 |
| City | BRASELTON |
| State | GA |
| Zip Code | 30517 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609944115 | Gwinnett Clinic,ltd | Legal Medicine | 5196 Hwy 53, Braselton, GA 30517 | 2006-12-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063904076 | Northeast Georgia Dental Group | Dentist | 1205 Friendship Road, Braselton, GA 30517 | 2018-06-05 |
| 1548772544 | Shaniqua Lynee Sims | Nurse Practitioner | 1515 River Pl Ste 280, Braselton, GA 30517 | 2017-10-30 |
| 1538671847 | Georgia Pain and Wellness Center | Durable Medical Equipment & Medical Supplies | 1255 Frienship Road, Suite 150, Braselton, GA 30517 | 2017-10-26 |
| 1295137735 | Connie Johnson | Occupational Therapy Assistant | 5373 Thompsons Mill Rd., Braselton, GA 30517 | 2014-09-16 |
| 1780970921 | Christopher Thomas Middendorf | Hospitalist | 1400 River Place, Braselton, GA 30517 | 2011-06-27 |
| 1407140999 | Ashley Williams Zimmerman | Registered Nurse | 1515 River Pl Ste 340, Braselton, GA 30517 | 2011-06-02 |
| 1891097382 | Thu Mong Tran Nguyen | Dentist | 1702 Ammon Falls Ct, Braselton, GA 30517 | 2010-12-03 |
| 1053436030 | Andrew L Tam | Dentist | 5122 Hwy 53, Braselton, GA 30517 | 2007-03-20 |
| 1871503987 | Kathy Baxendale Morse | Nurse Practitioner | 2695 Old Winder Hwy, Suite 200, Pediatric Associates, Braselton, GA 30517 | 2006-08-09 |
| 1770568792 | Prasad S Garimella | Internal Medicine | 1400 River Pl, Braselton, GA 30517 | 2005-12-13 |
| Find all providers in zip 30517 | ||||
| Taxonomy Code | 173000000X |
| Grouping | Other Service Providers |
| Classification | Legal Medicine |
| The specialty areas of medicine concerned with matters of, and relations with, substantive law and legal institutions; such as the conduct of medical examinations at crime scenes, performance of autopsies, giving of expert medical testimony in judicial proceedings, medical treatment of inmates of penal institutions, the practice of trauma medicine in law enforcement settings, and other clinical practice and medical science applications in the fields of law, law enforcement, and corrections. |
| Notes: Source: Rhea, Ott, and Shafritz, The Facts On File Dictionary of Health Care Management, New York: Facts On File Publications, 1988. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609944115 | Gwinnett Clinic,ltd | Legal Medicine | 5196 Hwy 53, Braselton, GA 30517 | 2006-12-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568790061 | Gwinnett Clinic, Ltd | Legal Medicine | 2748 Winder Hwy, Jefferson, GA 30549-8736 | 2009-11-23 |
| 1790939163 | Gwinnett Clinic, Ltd | Legal Medicine | 1383 Atlanta Highway, Auburn, GA 30011 | 2008-11-11 |
| 1932379666 | Medical Centre | Legal Medicine | 1815 Highway 138 Se Ste 800, Conyers, GA 30013-2098 | 2008-03-10 |
| 1215112321 | Tina M. Mason, M.d., L.L.C. | Legal Medicine | 935 River Centre Pl, Suite 200, Lawrenceville, GA 30043-7322 | 2008-01-08 |
| 1639350515 | Leeway Medical Group, PC | Legal Medicine | 1665 Waterway Xing Sw, Atlanta, GA 30331-8060 | 2007-11-19 |
| 1891975470 | Metro Vascular, P.C. | Legal Medicine | 2675 N Decatur Rd Ste 210, Suite 210, Decatur, GA 30033-6132 | 2007-11-12 |
| 1710183454 | South Atlanta Primary Care PC | Legal Medicine | 6568a Tara Blvd, Jonesboro, GA 30236-1228 | 2007-06-21 |
| 1902013709 | Winship Clinic,p.c. | Legal Medicine | 2401 Brookstone Centre Pkwy, Bldg. 200, Columbus, GA 31904-4501 | 2007-05-17 |
| 1801911789 | Ronald Ivan Kaplan | Legal Medicine | 333 Sandy Springs Cir Ne, Suite 200, Atlanta, GA 30328-3897 | 2007-03-20 |
| 1730213547 | Cobb Pulmonary Associates PC | Legal Medicine | 140 Vann St Ne Ste 340, Marietta, GA 30060-7297 | 2007-03-15 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.