Healthcare Provider Details

I. General information

NPI: 1508975269
Provider Name (Legal Business Name): ROBERT MARION PATTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 12/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4403 HOLLY AVE
COLUMBUS GA
31904-6525
US

IV. Provider business mailing address

4403 HOLLY AVE
COLUMBUS GA
31904-6525
US

V. Phone/Fax

Practice location:
  • Phone: 706-322-5511
  • Fax: 706-322-6010
Mailing address:
  • Phone: 706-322-5511
  • Fax: 706-322-6010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number17258
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: