MEDICARE: PATRICK BANKS

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	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1912505736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICK BANKS

Provider Business Mailing Address
First Line	:	3390 N LUMPKIN RD APT 1108
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31903-2120
Country	:	US
Telephone Number	:	706-326-8253
Fax Number	:

Provider Business Practice Location Address
First Line	:	3390 N LUMPKIN RD APT 1108
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31903-2120
Country	:	US
Telephone Number	:	706-326-8253
Fax Number	:

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

Provider Enumeration Date	:	10/14/2020
Last Update Date	:	10/14/2020

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Directions to “ PATRICK BANKS ” Practice Location

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