Individual
NIBEDITA PATRO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1080 SANDERS RD, STE 100, CUMMING, GA 30041-8057
(770) 887-2323
(770) 887-2325
Mailing address
1080 SANDERS RD, STE 100, CUMMING, GA 30041-8057
(770) 887-2323
(770) 887-2325
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
058092
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000974509L
—
GA
05
—
000974509M
—
GA
05
—
000974509N
—
GA
05
—
085000920G
—
GA
Enumeration date
09/25/2006
Last updated
02/26/2021
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