Active NPI
Dharmaraj Halligouda Patil, M.D.
- Internal Medicine Physician
- Alpharetta, GA
National Provider Identifier
1558355685
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 042386
- Practice address
- 11379 Southbridge Pkwy
Suite a
Alpharetta, GA 30022-4469 - Phone
- (770) 777-0750
- Fax
- (770) 777-0521
- NPI assigned
- Sep 5, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 042386 | GA | Primary |
Addresses
Primary practice location
11379 Southbridge Pkwy
Suite a
Alpharetta, GA 30022-4469
Mailing address
11379 Southbridge Pkwy
Suite a
Alpharetta, GA 30022-4469
Phone (770) 777-0750
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00744191F | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 042386 | GA | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Metro Medical Associates of Decatur, LLC | Internal Medicine | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Adult Medicine Physician
- Decatur, GA
- NPI 1043526114
Internal Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1125878400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1184198400000",
"number": "1558355685",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11379 SOUTHBRIDGE PKWY",
"address_2": "SUITE A",
"city": "ALPHARETTA",
"state": "GA",
"postal_code": "300224469",
"telephone_number": "770-777-0750",
"fax_number": "770-777-0521"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11379 SOUTHBRIDGE PKWY",
"address_2": "SUITE A",
"city": "ALPHARETTA",
"state": "GA",
"postal_code": "300224469",
"telephone_number": "770-777-0750",
"fax_number": "770-777-0521"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PATIL",
"first_name": "DHARMARAJ",
"middle_name": "HALLIGOUDA",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-09-05",
"last_updated": "2007-07-12",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "GA",
"license": "042386",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00744191F",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Alpharetta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.