Healthcare Provider Details

I. General information

NPI: 1134536881
Provider Name (Legal Business Name): DAVID PATCH ATC, MED
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2014
Last Update Date: 03/30/2022
Certification Date: 03/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ORTHOPAEDIC SURGERY RESIDENCY PROGRAM UAB
BIRMINGHAM AL
35294-0001
US

IV. Provider business mailing address

PEDIATRIC RESIDENCY PROGRAM, MEMORIAL UNIVERSITY MEDICAL CENTER 4700 WATERS AVENUE
SAVANNAH GA
31404
US

V. Phone/Fax

Practice location:
  • Phone: 205-934-6413
  • Fax:
Mailing address:
  • Phone: 912-350-8193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2000009788
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: