Healthcare Provider Details

I. General information

NPI: 1306555412
Provider Name (Legal Business Name): LEIA PATTERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2022
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2865 HOSEA L WILLIAMS DR SE
ATLANTA GA
30317-3052
US

IV. Provider business mailing address

2865 HOSEA L WILLIAMS DR SE
ATLANTA GA
30317-3052
US

V. Phone/Fax

Practice location:
  • Phone: 678-410-8385
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number264101
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN264101
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberRN264101
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: