Healthcare Provider Details

I. General information

NPI: 1366730822
Provider Name (Legal Business Name): COURTNEY PATTON PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2011
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1432 DRESDEN DR NE STE 300
BROOKHAVEN GA
30319-3593
US

IV. Provider business mailing address

2356 MASON DR
ATLANTA GA
30316-4516
US

V. Phone/Fax

Practice location:
  • Phone: 404-816-8801
  • Fax:
Mailing address:
  • Phone: 704-763-1788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number10961
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: