Individual provider Active NPI

Dola Tejaskumar Patel, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Tifton, GA
National Provider Identifier
1023607140
Registry record updated Jan 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
RN241460 Issued in GA
Practice address
334 Tifton Eldorado Rd
Tifton, GA 31794-9497
Phone
(229) 391-2301
Fax
(229) 386-3221
NPI assigned
Jan 13, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X RN241460 GA Primary

Addresses

Primary practice location

334 Tifton Eldorado Rd
Tifton, GA 31794-9497

Mailing address

3120 N Oak Street Ext Ste C
Valdosta, GA 31602-5910
Phone (229) 391-2301

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210128001101 GA Practitioner - Nurse Practitioner 7214341544 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Behavioral Health Services of South GeorgiaGroup PAC ID 0840181426, 15 clinicians

Practice addresses (Care Compare)

334 Tifton Eldorado Rd
Tifton, GA 31794-9497
Phone (229) 391-2301

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Behavioral Health Services of South Georgia CurrentSince Jan 19, 2021 Accepting new patients
Behavioral Health Crisis Center Past Accepting new patients

Locations

203 Industrial Park Dr
Adel, GA 31620
Phone (229) 896-4559

334 Tifton Eldorado Rd
Tifton, GA 31794
Phone (229) 391-2300

3120 N Oak Street Ext
Ste B
Valdosta, GA 31602
Phone (229) 671-6164

3120 N Oak Street Ext
Ste C
Valdosta, GA 31602
Phone (229) 671-6100

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1610496000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611273600000",
    "number": "1023607140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3120 N OAK STREET EXT STE C",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316025910",
            "telephone_number": "229-391-2301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "334 TIFTON ELDORADO RD",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317949497",
            "telephone_number": "229-391-2301",
            "fax_number": "229-386-3221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PATEL",
        "first_name": "DOLA",
        "middle_name": "TEJASKUMAR",
        "credential": "PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-01-13",
        "last_updated": "2021-01-22",
        "certification_date": "2021-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "GA",
            "license": "RN241460",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tifton, GA

Sources for this page

Verify at the official NPI Registry.