Healthcare Provider Details

I. General information

NPI: 1982154464
Provider Name (Legal Business Name): KATISHA PATTERSON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2016
Last Update Date: 11/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 PEACHTREE ST NE SUITE 1275
ATLANTA GA
30308-2212
US

IV. Provider business mailing address

550 PEACHTREE ST NE SUITE 1275
ATLANTA GA
30308-2212
US

V. Phone/Fax

Practice location:
  • Phone: 404-872-3121
  • Fax: 404-872-3119
Mailing address:
  • Phone: 404-872-3121
  • Fax: 404-872-3119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN214709
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberRN214709
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: