MEDICARE: PICKENS ANDREW PATTERSON III MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	23964	SC
2	208VP0014X	Interventional Pain Medicine Physician	057737	GA

General Provider Information

NPI Number	:	1316926058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PICKENS ANDREW PATTERSON III MD

Provider Business Mailing Address
First Line	:	1388A WELLBROOK CIR NE
Second Line	:
City	:	CONYERS
State	:	GA
Zip	:	30012-3872
Country	:	US
Telephone Number	:	678-733-9666
Fax Number	:	404-344-6575

Provider Business Practice Location Address
First Line	:	3885 PRINCETON LAKES WAY SW
Second Line	:	STE 400
City	:	ATLANTA
State	:	GA
Zip	:	30331-5589
Country	:	US
Telephone Number	:	678-733-9666
Fax Number	:	404-344-6575

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2006
Last Update Date	:	10/24/2012

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