Healthcare Provider Details

I. General information

NPI: 1700893963
Provider Name (Legal Business Name): PATRICIA P INGOLD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 08/01/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 19TH ST
COLUMBUS GA
31901-1528
US

IV. Provider business mailing address

2300 MANCHESTER EXPY STE 2001A
COLUMBUS GA
31904-6802
US

V. Phone/Fax

Practice location:
  • Phone: 706-322-7884
  • Fax: 706-243-4356
Mailing address:
  • Phone: 706-320-3126
  • Fax: 706-320-3054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number004546
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: