Champak Patel, MD

Primary specialty

Legal MedicineTaxonomy code 173000000X

License

059888 Issued in GA

Practice address

5196 Hwy 53
Braselton, GA 30517

Phone

(706) 824-9929

Fax

(706) 654-9373

NPI assigned

Feb 6, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 7

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Gwinnett Clinic LTD

  • Multi-Specialty Clinic/Center
  • Duluth, GA
  • NPI 1629117650

  Legal Medicine

  NPD (past)

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

{
    "created_epoch": "1139184000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1213228800000",
    "number": "1073585782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "455 BEAVER RUIN RD",
            "city": "LILBURN",
            "state": "GA",
            "postal_code": "30047",
            "telephone_number": "770-923-7778",
            "fax_number": "770-806-1383"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5196 HWY 53",
            "city": "BRASELTON",
            "state": "GA",
            "postal_code": "30517",
            "telephone_number": "706-824-9929",
            "fax_number": "706-654-9373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PATEL",
        "first_name": "CHAMPAK",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-06",
        "last_updated": "2008-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "NY",
            "license": "123503",
            "primary": false
        },
        {
            "code": "173000000X",
            "taxonomy_group": "",
            "desc": "Legal Medicine",
            "state": "GA",
            "license": "059888",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "000411428001",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00525411",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHI",
            "identifier": "75786IM",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MVP",
            "identifier": "11136",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "141618275",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EMPIRE",
            "identifier": "349351",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "554972145A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Han Sol Park, DO
• Lena Park, DMD
• Kathryn Elise Parris, M.D.
• James Keelan Passmore, MD
• Ankit Arvindbhai Patel, MD
• Kalpit Patel, M.D.
• Miral Patel, MD
• Pavan Patel
• Saloni N Patel, MD
• Lee Justin Payne, DMD

• Legal Medicine in Braselton, GA
• Providers in Braselton, GA by specialty
• Legal Medicine in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.