MEDICARE: MADISSEN PATTERSON

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	390200000X	Student in an Organized Health Care Education/Training Program	S12300	AL

General Provider Information

NPI Number	:	1407327067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADISSEN PATTERSON

Provider Business Mailing Address
First Line	:	447 W LONGLEAF DR APT 601
Second Line	:
City	:	AUBURN
State	:	AL
Zip	:	36832-7411
Country	:	US
Telephone Number	:	256-497-9210
Fax Number	:

Provider Business Practice Location Address
First Line	:	2320 MOORES MILL RD STE 100
Second Line	:
City	:	AUBURN
State	:	AL
Zip	:	36830-8403
Country	:	US
Telephone Number	:	334-887-8780
Fax Number	:

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

Provider Enumeration Date	:	12/07/2018
Last Update Date	:	12/07/2018

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Directions to “ MADISSEN PATTERSON ” Practice Location

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